Detached ciliary tufts are structures of doubtful pathologic significance that are normally present in many body fluids. However, their existence is not widely appreciated by pathologists practicing routine laboratory medicine. If they are observed, their practical clinicopathologic importance is that, because of their vigorous ciliary motion in wet mounts, they can imitate ciliated protozoa and pose a diagnostic dilemma. The authors present a brief review of the literature on detached ciliary tufts and a morphologic comparison with the more commonly encountered intestinal protozoa.
A 43-year-old white man presented with a 1-year history of lethargy, intermittent arthralgia affecting his hands and knees and a pruritic eruption, starting on his arms and then spreading to his neck and chest. He did not have diabetes. On physical examination, clusters of firm, shiny, translucent papules and small nodules were seen on the patient's cheeks and neck. Above his eyebrows, these papules were arranged in a line and were also prominent at periungual sites. Patches of erythema were present on his neck and torso and xanthelasma were noted bilaterally (Fig. 1). There was no mucosal involvement, lymphadenopathy or organomegaly. Radiography of the hands and knee joints did not reveal any destructive changes, and full body computed tomography did not show any evidence of internal malignancy. Autoimmune screening blood tests gave normal results, while erythrocyte sedimentation rate, uric acid levels and serum electrophoresis were all normal, and human immunodeficiency and hepatitis serology was negative. Serum angiotensin level was raised at 80 U/L (normal range 8-53 U/L) and total cholesterol and triglyceride levels were marginally raised at 5.4 mmol/L and 1.9 mmol/L, respectively (normal ranges < 5.2 mmol/L and 0.4-1.9 mmol/L, respectively).
Histopathological findingsA punch biopsy taken from a nodule on the patient's neck showed a circumscribed cluster of mononuclear and multinucleate histiocytes with eosinophilic 'ground-glass' cytoplasm (Fig. 2). The cells were negative for Melan A, S100 and HMB45 but positive for periodic-acid-Schiff (PAS) and CD68.
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