Diagnostic utility of fine needle aspiration cytology of sensory cutaneous nerve in leprosy

Authors

  • Reena Naik MBBS, DNB (Pathology), Assistant Prof in Pathology, Govt Medical College (LSLAMMC), Raigarh, Chhattisgarh
  • Dilip Kumar Sa MD (Skin &VD), Asso Prof of Skin &VD , Govt Medical College(LSLAMMC), Raigarh, Chhattisgarh
  • Kishori Moni Panda MD (Pathology), Prof of Pathology, Govt Medical College(LSLAMMC), Raigarh, Chhattisgarh

Keywords:

Peripheral neuropathy, Fine-needle aspiration cytology (FNAC), Hansen’s disease, lepra bacilli, sensory cutaneous nerve.

Abstract

Background: Peripheral neuropathy is a central feature of  leprosy. Intraneural inflammation caused by  M. leprae is the  morphological hallmark of this disease,  FNAC of sensory cutaneous nerve has proved to be a valuable diagnostic tool.

Materials and methods: The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period from Nov 2014 to Sept 2015. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides were screened for Schwann cells, granuloma, and necrosis. Modifi ed Ziehl-Neelsen (ZN)-stained smears were searched for single lepra bacilli and globi.

Results: Twenty-five sensory cutaneous nerves were aspirated. Out of which 19 yielded diagnostic aspirate. Five cytologic pictures were seen - epithelioid cell granulomas (6), epithelioidcell granulomas with necrosis (3);necrosis + lepra bacilli (4); only lepra bacilli (2); and lymphocyte & macrophage infiltrate (4).Following the Ridley-Jopling classification, in our study there were 9 cases of TT, 4 of BT-TT, 1 of BB, 2 of BL, and 3 of LL.

Conclusion: FNAC of sensory cutaneous nerve is useful in diagnosis and classification of leprosy on the R-J scale.

DOI: 10.21276/APALM.1178

References

1. Alexander J., Mc Adam, Milner DA, Sharpe AH. Infectitious diseases. In: Kumar, Abbas, Aster editors. Robbins and Cotran Pathologic basis of disease. 9 th edition Saunders/Elsevier, Philadelphia 2014:377
2. E. Wilder-Smith, “Diagnosis of pure neuritic leprosy,” Neurological Journal of South East Asia 2002;7: 61–63
3. Prasoon D, Mandal SK, Agrawal P. Sensory cutaneous nerve fine-needle aspiration in Hansen’s disease: A retrospective analysis of our experience. J Cytol 2015;32:170-75.
4. Singh N, Bhatia A, Gupta K, Ramam M. Cytomorphology of Leprosy across the Ridley Jopling spectrum. Acta Cytol 1996;40:719-23.
5. Jopling WH, McDougall AC. Definition, epidemiology and world distribution. In: Jopling WH, McDougall AC, editors. Handbook of Leprosy. 5 th ed.CBS Publishers, New Delhi 1996:1.
6. Noordeen SK. The epidemiology of leprosy. In: Hastings RC, Opromolla DVA editors.Leprosy 2 nd ed. Churchill Livingstone, London 1994:29-45.
7. WHO Expert committee on leprosy 1988 Sixth report. Technical Report Series 768, Geneva: World Health Organization.
8. Ridley DS, Jopling WH. Classification of leprosy according to immunity: A five group system. Int J Lepr 1966;34:255-73.
9. Ridley MJ. The cellular exudate: Mycobacterium leprae relationship and the critical reading of slit smears. Lepr Rev 1989;60:229-40.
10. Singh N, Arora VK, Ramam M. Nodular lepromatous leprosy: Report of a case diagnosed by FNA. Diagn Cytopathol 1994;11:373-5.
11. Siddaraju N, Yaranal PJ, “Use of fine needle aspiration cytology in leprotic lesions: a report of 4 cases,” Acta Cytologica 2007;51: 235–238
12. Theuvenet WZ, Miyazaki N, Roche PW, and Shrestha I, “Cytological needle aspiration of the nerve for the diagnosis of pure neural leprosy,” International Journal of Leprosy 1993; 61:597–599
13. Jayaseelan E, Shariff S, Rout P, “Cytodiagnosis of primary neuritic leprosy,” International Journal of Leprosy and Other Mycobacterial Diseases 1999;67: 429–434
14. Siddaraju N, Sistla SC, Singh N et al., “Pure neuritic leprosy with nerve abscess presenting as a cystic, soft tissue mass: report of a case diagnosed by fine needle aspiration cytology,” Diagnostic Cytopathology 2009;37:355-8
15. Vijaikumar M, D'Souza M, Kumar S, Badhe B, “Fine needle aspiration cytology (FNAC) of nerves in leprosy,” Leprosy Review 2001;72:171–178
16. Singh N, Malik A, Arora VK, Bhatia A, “Fine needle aspiration cytology of leprous neuritis,” Acta Cytologica 2003;47: 368–372
17. Rao IS, Singh MK, Datta SK, Pandhi RK, Kapila K. “Utility of fine-needle aspiration cytology in the classification of leprosy,” Diagnostic Cytopathology 2001;24:317–321
18. Prasad PV, George RV, Kaviarasan PK, Viswanathan P, Tippoo R, Anandhi C, “Fine needle aspiration cytology in leprosy,” Indian Journal of Dermatology, Venereology and Leprology 2008;74:352–356
19. Jaswal TS, Jain VK, Jain V, Singh M, Kishore K, Singh S. “Evaluation of leprosy lesions by skin smear cytology in comparison to histopathology,” Indian Journal of Pathology and Microbiology 2001;44:277–281

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Published

07-04-2017

How to Cite

1.
Naik R, Sa DK, Panda KM. Diagnostic utility of fine needle aspiration cytology of sensory cutaneous nerve in leprosy. Ann of Pathol and Lab Med [Internet]. 2017 Apr. 7 [cited 2025 Feb. 5];4(2):A157-162. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1178

Issue

Vol. 4 No. 2 (2017)

Section

Original Article

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Copyright (c) 2017 Reena Naik, Dilip Kumar Sa, Kishori Moni Panda

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