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Year : 2015  |  Volume : 58  |  Issue : 3  |  Page : 400-401
Myiasis in vulvar carcinoma in a patient with acquired immune deficiency syndrome


1 Department of Pathology, Grant Government Medical College and Sir J. J. Hospital, Mumbai, Maharashtra, India
2 Government Medical College, Miraj, Maharashtra, India
3 Department of Surgical Pathology, Metropolis Health Care, Mumbai, Maharashtra, India

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Date of Web Publication14-Aug-2015
 

How to cite this article:
Lanjewar DN, Aagle S, Dongaonkar D, Murthy A. Myiasis in vulvar carcinoma in a patient with acquired immune deficiency syndrome. Indian J Pathol Microbiol 2015;58:400-1

How to cite this URL:
Lanjewar DN, Aagle S, Dongaonkar D, Murthy A. Myiasis in vulvar carcinoma in a patient with acquired immune deficiency syndrome. Indian J Pathol Microbiol [serial online] 2015 [cited 2022 Jan 22];58:400-1. Available from: https://www.ijpmonline.org/text.asp?2015/58/3/400/162932


The word myiasis comes from the Greek word mya means fly and is defined as the infestation of live vertebrate animals with dipterous larvae that feed on the host's dead or living tissue, developing as parasites. A 32-year-old, HIV-infected commercial sex worker who was on treatment with highly active antiretroviral therapy, presented with nodular and ulcerative growth on left labia majora; the punch biopsy of it confirmed the diagnosis of squamous cell carcinoma. Laboratory investigations showed CD4 cell count 61 cells/mm 3 , the clinical course of the patient was characterized by extensive necrosis of vulvar carcinoma hence wide excision of growth along with dissection of left-sided inguinal lymph nodes was carried out and specimen was sent for histopathological evaluation.

A specimen of nodular growth measured 5 cm × 5 cm in size, microscopic examination of the tumor showed sheets and nests of polygonal cells with scant cytoplasm and hyperchromatic nuclei [Figure 1]a. The tumor cells expressed the human papilloma virus antigen. In between tumor cells, a transversely cut section of parasite was identified. The histological feature of parasite showed oval structure having outer thin membranous cuticle that was covered with pigmented spines; the striated muscle was found directly under the cuticle [Figure 1]b-d. The body cavity showed large and small tubular structures lined by cuboidal epithelium. This morphologic feature of parasite was indicative of a diagnosis of myiasis. Therefore, to confirm this diagnosis, more clinical details were collected from the treating gynecologist. Gynecologist informed that the patient had maggots in the vulvar growth; and further informed that before surgical excision the maggot containing growth was cleaned with hydrogen peroxide and ether and several maggots were mechanically removed. With clinical correlation and microscopic features, a confirmative diagnosis of myiasis was made.
Figure 1: (a) Microscopic examination of the vulvar tumor shows sheets and nests of tumor cells having hyperchromatic nuclei and scant cytoplasm (H and E, ×400); (b) A transversely cut section of parasite (H and E, ×200); (c) Body cavity of parasite shows tubular structures lined by cuboidal epithelium, skeletal muscle and pigmented spines in outer cuticle (H and E, ×400); (d) Outer cuticle of parasite shows skeletal muscle and spine (H and E, ×1000)


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The distribution of human myiasis is worldwide, with more species and greater abundance in poor socioeconomic regions of tropical and subtropical countries. In primary myiasis larvae feed on living tissues while in secondary myiasis larvae feed on necrotic tissue and accidental or pseudomyiasis is caused by the ingestion of eggs of obligatory myiasis producing fly.

Urogenital myiasis affects women more commonly, and cases of urogenital myiasis are most frequently documented from Brazil, Sri Lanka and India. [1],[2],[3] A lack of underwear, urethral discharge, and sexually transmitted diseases are all peculiar predisposing factors. In females, myiasis is usually associated with promiscuous sexual behavior; our patient had multiple sexual partners. Only one report of vulvar myiasis is described in HIV-infected female, [1] and to the best of our knowledge our case is the first report of myiasis in vulvar carcinoma in a patient with AIDS.

Poor sanitation is probably the most important risk factor for human myiasis. Low socioeconomic status, especially in poor countries, has an intimate relationship with lack of basic sanitation and inadequate garbage disposal, leaving organic material exposed which attracts insects and small animals, creating a sustainable cycle of filth. Adequate sanitation can be reached only when government, population, and education programs work together. Making sure wounds are cleaned and dressed regularly, and more in regions of endemicity, sleeping nude, sleeping outdoors, and sleeping on the floor should be avoided. Drying clothes in bright sunlight and ironing them are effective methods of destroying occult eggs laid in clothing.

Malignant tumors are well-recognized as a predisposing factor for myiasis; and are more commonly related to open-skin malignancies such as squamous cell carcinoma. [4] The lack of personal hygiene is the contributing factor for the cause of myiasis, more so with the genital myiasis. The importance of this disease in terms of public health is obvious since there is a strong social connotation associated with this type of infestation that is closely linked to poverty and a lack of primary healthcare. Occasional report describing light microscopic features of the larva is described in the literature. [5] Biopsies are not necessary for the diagnosis of myiasis; however, when accurate clinical information regarding the presence of larva is not available, and invasive larva are seen in tissue section then it poses the problem of microscopic diagnosis.

 
   References Top

1.
Passos MR, Varella RQ, Tavares RR, Barreto NA, Santos CC, Pinheiro VM, et al. Vulvar myiasis during pregnancy. Infect Dis Obstet Gynecol 2002;10:153-8.  Back to cited text no. 1
    
2.
Atapattu HD. A case of vulvar myiasis. Sri Lanka J Obstet Gynaecol 2010;32:21-2.  Back to cited text no. 2
    
3.
Raja AM, Vidhyashree, Pushpa KP. Vulval myiasis in a rural setting: A case report. Int J Adv Res 2014;2:422-4.  Back to cited text no. 3
    
4.
Carvalho RW, Santos TS, Antunes AA, Laureano Filho JR, Anjos ED, Catunda RB. Oral and maxillofacial myiasis associated with epidermoid carcinoma: A case report. J Oral Sci 2008;50:103-5.  Back to cited text no. 4
    
5.
Baker DJ, Kantor GR, Stierstorfer MB, Brady G. Furuncular myiasis from Dermatobia hominis infestation. Diagnosis by light microscopy. Am J Dermatopathol 1995;17:389-94.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Dhaneshwar Namdeorao Lanjewar
Professor of Pathology, Grant Government Medical College and Sir J. J. Hospital, Byculla, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None declared. This is written twice. Another is written after legends description hence this can be deleted.


DOI: 10.4103/0377-4929.162932

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