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Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 59-61  

Lymphatic filariasis presenting as retroperitoneal cyst


1 Department of Surgical Pathology, Sancheti Histopathology Laboratory, Nagpur, Maharashtra, India
2 Department of Surgery, Gopal Surgical Hospital, Nagpur, Maharashtra, India

Date of Submission31-Oct-2019
Date of Acceptance30-Jan-2020
Date of Web Publication20-May-2020

Correspondence Address:
Prachi M Sancheti
Ground Floor, Shriman Palace, Opposite Crescent Hospital, Near Lokmat Square, Dhantoli - 440 012, Nagpur, Maharashtra
India
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DOI: 10.4103/tp.TP_73_19

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   Abstract 


Filariasis is endemic in the tropical and subtropical regions of the world. Lymphatic filariasis presents commonly as hydrocele, lymphocele, lymphadenopathy, pitting edema, elephantiasis, or subclinical microfilaremia. Here, we present a case of filariasis presenting as a retroperitoneal cyst, which was diagnosed on identification of microfilaria in the cyst fluid and cyst wall.

Keywords: Filariasis, microfilaria, retroperitoneal cyst


How to cite this article:
Sancheti PM, Naikwade RR. Lymphatic filariasis presenting as retroperitoneal cyst. Trop Parasitol 2020;10:59-61

How to cite this URL:
Sancheti PM, Naikwade RR. Lymphatic filariasis presenting as retroperitoneal cyst. Trop Parasitol [serial online] 2020 [cited 2020 Aug 7];10:59-61. Available from: http://www.tropicalparasitology.org/text.asp?2020/10/1/59/284617




   Introduction Top


Filariasis is a parasitic disease caused by an infection with roundworms of the Filarioidea type.[1] It is common in most tropical and subtropical regions of the world.[1] Filariasis presenting primarily as a retroperitoneal cyst is very rare. Very few cases have been reported in the literature.[2],[3],[4] Here, we present a case of filariasis presenting unusually in the form of a retroperitoneal cyst and diagnosed by identification of microfilariae in the cyst fluid and cyst wall.


   Case Report Top


A 35-year-old male, resident of Gorakhpur, Uttar Pradesh, complained of gradually increasing lump in the abdomen for the last 6 months. Computed tomographic scan showed a large (29 cm × 28 cm) retroperitoneal cystic lesion with multiple thin septations?Mesenteric cyst. Because of the considerable size of the lesion, laparotomy with surgical excision was performed. Specimen of the cyst wall and cyst fluid was submitted for histopathology and cytology, respectively.

Cyst wall measuring 22 cm × 18 cm was received. The wall was thin transparent with multiple thin septations. No solid areas were seen [Figure 1]. Five milliliters of hemorrhagic cyst fluid received was centrifuged, and smears were prepared for cytological examination. Giemsa-stained smears of the cyst fluid revealed many microfilariae morphologically consistent with Wuchereria bancrofti[Figure 2]. The cyst wall on histopathological examination revealed multiple dilated lymphatic spaces. Dead and calcified forms of the parasite surrounded by inflammation and foreign body reaction could be seen in the wall [Figure 3]. The patient was administered diethylcarbamazine as a provocative maneuver and subsequent examination of the peripheral blood smear also revealed microfilariae. The patient was treated with complete course of diethylcarbamazine and has remained asymptomatic on subsequent follow-up.
Figure 1: Thin transparent retroperitoneal cyst wall

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Figure 2: Microfilaria in the cyst fluid (Giemsa stain)

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Figure 3: Dilated lymphatic spaces with calcified parasite seen in the wall

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   Discussion Top


Filariasis is an endemic infection of the tropical and subtropical areas. Lymphatic filariasis is caused by three species of the worms, W. bancrofti, Brugia malayi, and Brugia timori.[1] It presents most commonly as hydrocele, lymphocele, lymphadenopathy, pitting edema, elephantiasis, etc., due to occlusion of the lymphatic channels and lymphangiectasia.[1] Filarial retroperitoneal cysts have a reported incidence of 1 in 105,000 hospitalized patients.[5],[6] Only few cases have been reported.[2],[3],[4],[5],[6] Kapoor et al. reported a case of microfilarial retroperitoneal cyst, diagnosed preoperatively on the demonstration of microfilaria in the aspirated cyst fluid.[2] Ganesan et al. reported a case of a large retroperitoneal cyst, for which abdominal exploration had to be performed due to diagnostic uncertainty. The histopathology of the excised cyst showed numerous cystic spaces packed with microfilariae.[3] Bakde et al. reported a case of retroperitoneal cyst which was diagnosed to be of lymphatic origin on radiological imaging. Associated mild collections in the scrotal sacs with moving echoes made them suspect filarial etiology. Microscopic examination of the cyst fluid confirmed their diagnosis.[4]

In our case, the patient did not give any significant history of fever. There was no scrotal swelling or inguinal lymphadenopathy. Hence, this is a rare presentation of filariasis in the form of a primary retroperitoneal cyst.

For a pathologist, it may not be much of a challenge to identify microfilaria. However, it is important to be aware of such rare presentations and diligently look for the organism in the submitted samples, as it may be sparse. The diagnosis may help the patient get definitive treatment and small such lesions may resolve by medical treatment and not require surgical removal.[7]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL. Harrison's Principles of Internal Medicine. 15th ed. New York: McGraw Hill; 2001. p. 1238.  Back to cited text no. 1
    
2.
Kapoor AK, Puri SK, Arora A, Upreti L, Puri AS. Case report: Filariasis presenting as an intra-abdominal cyst. Indian J Radiol Imaging 2011;21:18-20.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ganesan S, Galodha S, Saxena R. Retroperitoneal cyst: An uncommon presentation of filariasis. Case Rep Surg 2015;2015:Article ID 674252.  Back to cited text no. 3
    
4.
Bakde A, Disawal A, Taori K, Anand A, Gaur P, Agrawal M. Retroperitoneal cyst: An unusual presentation of filariasis. J Med Sci Health 2016;2:44-7.  Back to cited text no. 4
    
5.
Madhavan M, Vanaja SK, Chandra K, Reddy DJ. Atypical manifestations of filariasis in Pondycherry. Indian J Surg 1972;34:392-4.  Back to cited text no. 5
    
6.
Chittipantulu G, Veerabhadraiah K, Ramana GV, Somayajulu MV. Retroperitoneal cyst of filarial origin. J Assoc Physicians India 1987;35:386-7.  Back to cited text no. 6
    
7.
Giri A, Kundu AK, Chakraborty M, Das S. Microfilarial worms in retroperitoneal mass: A case report. Indian J Urol 2000;17:57-8.  Back to cited text no. 7
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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