title: Sensory cutaneous nerve fine-needle aspiration in Hansen's disease: A retrospective analysis of our experience.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Dr. Prasoon's Diagnostic Centre, Munger, Bihar, India.
authors.forename: Dev
authors.initials: D
authors.lastname: Prasoon
authors.affiliation: Department of Dermatology, Patliputra Medical College, Dhanbad, Jharkhand, India.
authors.forename: Swapan Kumar
authors.initials: SK
authors.lastname: Mandal
authors.affiliation: Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India.
authors.forename: Parimal
authors.initials: P
authors.lastname: Agrawal
keywords: Fine-needle aspiration (FNA) cytology; Hansen's disease; lepra bacilli; sensory cutaneous nerve