LAUSR

We read the publication on “Cysticercosis and cytodiagnosis” with great interest. Pal et al. concluded that “The cytological diagnosis of cysticercosis is quite straightforward in cases where the actual parasitic structures are identified in the smears. However, in the absence of parasitic fragments, features suggestive of host reaction should alert the cytologist to search for the evidence of cysticercosis in the smear.” We would like to share ideas and experience on this issue. Focusing on cytodiagnosis, getting parasite structure or the whole parasite is possible but it depends on the skill of the cytopathologist who collected the sample. According to the recent report from India, <50% of the fine-needle aspiration (FNA) could successfully get the parasite structure for cytological study. In case that part of parasite is derived, the differential diagnosis between cysticercosis and other tropical tissue parasite infestation such as sparganosis is needed. Focusing on sparganosis, a very high positive seroprevalence rate (62.5%) is reported in tropical Africa. Similar to cysticercosis, abnormal mass is the main clinical presentation of sparganosis. Smear from fine-needle aspiration cytology (FNAC) usually shows plenty of lymphocytes, plasma cells, and eosinophils in an inflammatory background and there might be part of helminth. Similar to cysticercosis, sparganosis is caused by a tapeworm. Hence, morphological identification is necessary for differential diagnosis. In our country, Thailand, a tropical country where cysticercosis is also endemic, the diagnosis by cytodiagnosis is rarely done since the final management for the lesion is usually the excision. The excision biopsy is usually used and can provide final diagnosis of cysticercosis without need to perform reoperation for surgical removal for treatment of parasite. Nevertheless, FNAC is still considered as useful diagnostic tool in many tropical countries where cysticercosis is common. In some occasions, the clinical diagnosis of cysticercosis is not possible, FNAC might plays important role in those situations.