Wuchereria bancrofti and Cytology: A Retrospective Analysis of 110 Cases from an Endemic Area

BACKGROUND: Wuchereriasis is a significant cause of chronic morbidity. It can affect any organ/tissue in the body. Fine-needle aspiration cytology (FNAC) is an easy method for its detection. A comprehensive analysis of the various facets involved has not been discussed in detail in any publication. MATERIALS AND METHODS: A twenty-six year (February 1994 to January 2020) retrospective audit of all patients who were cytologically diagnosed with wuchereriasis was performed. Data regarding age, sex, organ/tissue involved, and presence of co-existing disease were noted. Hematoxylin and eosin (H and E) and May-Grünwald-Giemsa (MGG) stained slides were screened for microfilaria, adult worm, larval forms, microfilaria ghosts, epithelioid cell granuloma, and eosinophils. RESULTS: Audit yielded 19,323 cases of which 110 had wuchereriasis giving an incidence of 0.57%. The 11–30 year age group accounted for 41.8% cases. Male: female ratio was 1.04:1. Duration of disease at presentation ranged from 3 days to 24 years. Lymph node was the commonest site involved (40%), followed by soft tissue (23.6%) and female breast (14.5%). Highest parasitic load was encountered in female breast aspirates. Microfilaria bancrofti was seen in 105 (95.4%) cases. In the five cases where microfilaria bancrofti was not encountered, diagnosis was established by the presence of adult gravid female worm (2 cases), coiled larvae (2 cases), and both adult gravid female worm and coiled larvae (1 case). Microfilaria ghosts were seen in 18.2% cases. Coexisting benign and malignant diseases were encountered in 17.3% and 13.6% cases, respectively. CONCLUSION: FNAC provides a simple and inexpensive means of detecting wuchereriasis and is preferred over histopathology. All stages of development of this nematode in human beings are identified in cytology. Microfilaria ghost is a useful clue in screening. The presence of granuloma and eosinophilic infiltrate indicates tissue reaction only. Patients with asymptomatic microfilaraemia should be reported in cytology as they merit treatment.