cytology is a widely accepted diagnostic procedure for a large variety of malignant and inflammatory lesions . skin - slit smear technique stained with ziehl - neelsen stain has been conventionally used for the assessment of the bacterial index and morphological index in lesions of leprosy . studies have been undertaken to evaluate the utility of fine needle aspiration cytology ( fnac ) in reactional and nonreactional leprosy lesions . we report two cases of lepromatous leprosy where fnac aided in early diagnosis of the lesions , later confirmed by histopathology . a 46-year - old woman presented with a swelling on the left wrist of 3-week duration . the swelling was 1.5 cm in diameter and a clinical diagnosis of  ganglion  was made . fnac of the lesion yielded whitish aspirate and slides were prepared and stained with giemsa stain . a 60-year - old man presented with multiple erythematous , raised , painful nodules over the back of 7-day duration along with type ii deformity of the nose and hand . he was a known case of bl leprosy on treatment . a clinical diagnosis of erythema nodosum leprosum ( enl ) type ii reaction was made . fnac was done from one of the lesions and slides were stained with giemsa stain . in both cases , aspirates from both the cases revealed cellular smears composed of large number of foamy macrophages with intracellular and extracellular  negative  images , scattered lymphocytes and histiocytes in a fatty background [ figure 1 ] . ziehl - neelsen staining showed bundles of intracellular and extracellular acid fast bacilli ( afb ) in both cases ( b.i.6 + ) [ figure 1 , inset ] . in the second case , cytological features of enl in the form of intact and degenerated polymorphonuclear leucocytes and fragmented afb were not found . microphotograph revealing abundant foamy macrophages with intracellular and extracellular negative images and interspersed lymphocytes in a fatty background ( giemsa , 400 ) . inset reveals bundles of intracellular and extracellular acid - fast lepra bacilli ( zn stain , 400 ) histopathology of both the lesions was done and the diagnosis of lepromatous leprosy was confirmed . a 46-year - old woman presented with a swelling on the left wrist of 3-week duration . the swelling was 1.5 cm in diameter and a clinical diagnosis of  ganglion  was made . fnac of the lesion yielded whitish aspirate and slides were prepared and stained with giemsa stain . a 60-year - old man presented with multiple erythematous , raised , painful nodules over the back of 7-day duration along with type ii deformity of the nose and hand . a clinical diagnosis of erythema nodosum leprosum ( enl ) type ii reaction was made . fnac was done from one of the lesions and slides were stained with giemsa stain . in both cases , aspirates from both the cases revealed cellular smears composed of large number of foamy macrophages with intracellular and extracellular  negative  images , scattered lymphocytes and histiocytes in a fatty background [ figure 1 ] . ziehl - neelsen staining showed bundles of intracellular and extracellular acid fast bacilli ( afb ) in both cases ( b.i.6 + ) [ figure 1 , inset ] . in the second case , cytological features of enl in the form of intact and degenerated polymorphonuclear leucocytes and fragmented afb were not found . microphotograph revealing abundant foamy macrophages with intracellular and extracellular negative images and interspersed lymphocytes in a fatty background ( giemsa , 400 ) . inset reveals bundles of intracellular and extracellular acid - fast lepra bacilli ( zn stain , 400 ) histopathology of both the lesions was done and the diagnosis of lepromatous leprosy was confirmed . leprosy , or hansen 's disease , is a slowly progressive infection caused by mycobacterium leprae , affecting the skin and peripheral nerves and resulting in disabling deformities . the ridley - jopling ( rj ) classification currently in use classifies leprosy into five clinically and histologically recognizable groups and helps predict the prognosis and possible complications . laboratory diagnosis of leprosy by skin - slit smears and skin biopsy is simple but both techniques have their limitations . skin - slit smears are negative in paucibacillary cases whereas , skin biopsy is an invasive procedure and leads to biopsy scar . fnac is a simple and safe technique and has been described as a useful tool for the diagnosis of leprosy in skin lesions and nerves . it has been observed that fna smears , in contrast to skin - slit smears , are free from confounding epidermal squamous cells and are therefore better suited for evaluating cell morphology . additionally , the skin - slit smears can only mention about the presence or absence of acid - fast bacilli whereas , fna can also help classify the lesion . singh et al . in 1995 attempted the cytological diagnosis and classification of leprosy and found 100% cytohistological concordance . rao et al . also evaluated the utility of fnac in the classification of leprosy and found 90% concordance in cases of tuberculoid leprosy and 93.75% concordance was observed in lepromatous leprosy . they , however , observed difficulty in differentiating tuberculoid leprosy ( tt ) from borderline tuberculoid leprosy ( bt ) and borderline lepromatous leprosy ( bl ) from lepromatous leprosy ( ll ) on cytology . found a fairly good correlation ( 77.3% ) of cytomorphological features with clinicopathological diagnosis in patients of leprosy . they also advocated aspiration from multiple sites for better concordance as was observed by singh et al . [ table 1 ] have been used in various studies for evaluation of fnac in leprosy . a study by prasad et al . included various types of skin lesions such as macules , papules , plaques and nodules . they observed macules in 42.5% cases which gave poor cellularity in cytology as was also observed by singh et al . fnac has also been used in the follow - up of patients with lepromatous leprosy . have defined cytomorphological features of reactions in leprosy with significant correlation in both type of reactions . our case report , hence emphasizes the role of fnac , which due to its rapidity and simplicity , can be used for early diagnosis and prompt management of cases of leprosy .
the  gold standard  for the diagnosis and classification of leprosy to date , is histological examination of skin biopsy in correlation with the bacteriological indices . these are , however , time - consuming . 
 an attempt was made to diagnose leprosy using fine needle aspiration cytology ( fnac ) which is a simple , safe , cost - effective and time - saving procedure with minimal trauma and complications . 
 this case report highlights the role of fnac in rapid diagnosis and early management , in patients of leprosy .