Prasoon Dev, Mandal Swapan Kumar, Agrawal Parimal
Department of Pathology, Dr. Prasoon's Diagnostic Centre, Munger, Bihar, India.
Department of Dermatology, Patliputra Medical College, Dhanbad, Jharkhand, India.
J Cytol. 2015 Jul-Sep;32(3):170-5. doi: 10.4103/0970-9371.168843.
Leprosy affects peripheral nerves. As Mycobacterium leprae has unique tropism for Schwann cells, thickened sensory cutaneous nerves provide an easy target for the detection of lepra bacilli and other changes associated with the disease.
The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period January 2006 to December 2014. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides were screened for Schwann cells, granuloma, and necrosis. Modified Ziehl-Neelsen (ZN)-stained smears were searched for lepra bacilli and globi. Morphological index was calculated in multibacillary lesions.
Twenty-nine sensory cutaneous nerves were aspirated in 23 patients. While 15 cases showed skin and nerve involvement, 8 cases showed only nerve involvement. Terminal cutaneous branch of the radial nerve was most often aspirated. No motor loss was observed after aspiration. Five cytologic pictures were seen - Epithelioid cell granuloma only in 6 cases, epithelioid cell granuloma with necrosis in 1 case, epithelioid cell granuloma with lepra bacilli in 3 cases, necrosis with lepra bacilli in 1 case, and only lepra bacilli in 12 cases. Morphological index ranged from 20% to 80%.
Sensory cutaneous nerve fine-needle aspiration (FNA) is a feasible, viable, effective, and safe procedure. It adds to diagnostic FNA yield in patients with concomitant skin involvement and offers a way to evaluate patients with only nerve involvement. Calculation of morphological index allows prognostication and may have a role in assessing response to therapy and/or relapse.
麻风病会影响周围神经。由于麻风分枝杆菌对施万细胞具有独特的嗜性，增厚的感觉性皮神经为检测麻风杆菌及与该疾病相关的其他变化提供了一个容易的靶点。
检索我院2006年1月至2014年12月期间有感觉性皮神经受累患者的数据。对苏木精和伊红（H&E）染色及美-格二氏（MGG）染色的玻片进行施万细胞、肉芽肿和坏死的筛查。在改良齐-尼（ZN）染色涂片上查找麻风杆菌和麻风球。计算多菌型病变的形态学指数。
23例患者共抽取了29条感觉性皮神经。其中15例有皮肤和神经受累，8例仅有神经受累。最常抽取的是桡神经的终末皮支。抽取后未观察到运动功能丧失。观察到5种细胞学表现——仅上皮样细胞肉芽肿6例，上皮样细胞肉芽肿伴坏死1例，上皮样细胞肉芽肿伴麻风杆菌3例，坏死伴麻风杆菌1例，仅麻风杆菌12例。形态学指数范围为20%至80%。
感觉性皮神经细针穿刺抽吸术（FNA）是一种可行、有效、安全的操作。它增加了伴有皮肤受累患者的诊断性FNA阳性率，并为仅神经受累的患者提供了一种评估方法。形态学指数的计算有助于预后判断，可能在评估治疗反应和/或复发方面发挥作用。
