Histopathological Examination Of Skin Lesions Research Articles

Clinicohistopathological Correlation in Leprosy Lesions: Study in a Tertiary Care Institute in Chhattisgarh

Background: Leprosy is a chronic granulomatous infectious disease, caused by Mycobacterium leprae. Early diagnosis is important to prevent morbidity caused by leprosy. However, accurate clinical or histopathological diagnosis is challenging especially in early skin lesions and in mid-borderline leprosy which shows overlapping features. Hence clinicohistopathological correlation is of utmost importance for accurate diagnosis. This study was conducted to evaluate the predominant subtype of leprosy in patients visiting for treatment in a tertiary care hospital, Chhattisgarh during the post-elimination phase in India.
 Methods: A retrospective study of 49 skin biopsies received from June 2019 to October 2020 was conducted in the Department of Pathology and Lab Medicine, AIIMS Raipur. Clinically suspected cases, outside diagnosed cases, and new lesions in treated cases of leprosy were included in this study. Clinical diagnosis was correlated with histopathological examination.
 Results: Among 49 skin biopsies, 34 cases were diagnosed as leprosy on histopathological examination. There was no evidence of leprosy in the remaining 15 cases. The most common type was borderline tuberculoid (35.3%), followed by Erythema nodosum leprosum (20.6%). Three cases were associated with type 1 lepra reaction. Among 34 confirmed cases of leprosy, 17(50.0%) cases were positive for acid-fast bacilli by Fite Faraco stain on histological sections. Maximum cases belonged to the age group of 31-40 years and the male to female ratio was 5.8:1.
 Conclusion: Histopathological examination of skin lesion along with Fite Faraco stain and clinical correlation is equally efficient for categorization and adequate treatment to achieve leprosy free world.

The histopathological spectrum of skin diseases with emphasis on clinicopathological correlation: A prospective study

The spectrum of skin disease varies greatly according to the age, gender and other factors. Skin biopsies are needed in challenging clinical cases. This study was done with aim of analyzing the spectrum of skin diseases in and around Meerut and to study the correlation between clinical and final histopathological diagnosis. This is a prospective study in which 282 skin biopsies received in Histopathology Department of LLRM Medical College Meerut, during December 2016 to December 2017. Among them 29 biopsies were inadequate and hence were not included. Remaining 253 biopsies were analyzed. The slides were stained with H & E stain. Definite histopathological diagnosis was possible in 240 cases (94.9%). A broad spectrum of diseases were seen comprising of infectious disorders (34.6%), eczematous disorders (10.8%), papulosquamous disorders (18.3%), vesicobullous lesions (2.9%), inflammatory disorders (5.8%), pigment disorders (3.8%), degenerative diseases (1.7%), benign tumors (17.5%) and malignant tumors (4.6%). The diversity of clinical manifestations of various skin diseases makes histopathological examination necessary for appropriate diagnosis and treatment. Histopathology also plays an important role in confirming an established clinical diagnosis. In this study, histopathology confirmed clinical diagnosis in 217 cases (85.8%), gave diagnosis different from clinical diagnosis in 23 cases (9.1%) and was noncontributory in only 13 cases (5.1%). This emphasizes that histopathological examination of skin lesions is an important tool for confirming skin diagnosis. Keywords: Histopathological diagnosis, Infectious disorders, Papulosquamous disorders.

Excess leukocytosis (leukemoid reaction) associated with feline non-flea, non-food hypersensitivity dermatitis in a young cat

A one and a half-year-old, male, castrated, domestic short-haired cat was presented with a six‑month history of depression, anorexia, skin lesions, excessive itching and systemic lymphadenopathy. Complete blood count revealed severe leukocytosis (114,700 cells/μl), and peripheral blood films were characterized by marked lymphocytosis. Lymph nodes examinations and bone marrow aspirate were not suggestive of neoplastic changes. Histopathologic examination of skin lesions revealed allergic dermatitis. Based on the anamnesis and histopathologic features, non-flea, non-food hypersensitivity dermatitis (NFNFHD) was diagnosed. Treatment was initiated with prednisolone and cyclosporine. During the treatment, the cat fully recovered from the skin lesions. Leukocytosis was reduced to 18,940/μl six months after initiation of medication. To the authors’ knowledge, this is the first report describing a case of a leukemoid reaction secondary to feline NFNFHD.

以早发性皮肤结节为诊断线索的假性甲状旁腺功能减退Ⅰa型二例临床特点和基因分析

Clinical features of and genetic mutations in two cases of pseudohypoparathyroidism type Ⅰa (PHPⅠa) with early-onset skin nodules were analyzed. Both of the two patients were males, and their ages at onset were 2 and 3 months respectively. They both presented with early-onset skin nodules as the main clinical manifestation, and were clinically characterized by a round face, short neck and early obesity. Histopathological examination of skin lesions showed subcutaneous ectopic osteogenesis in both patients. The first patient had low blood calcium, high blood phosphorus, high parathyroid hormone (PTH) , and gene sequencing showed a heterozygous mutation c.399delT causing a T base deletion at position 399 in exon 5 of the GNAS gene. The second patient had normal blood calcium and phosphorus levels as well as normal PTH levels at early stage, and gene sequencing showed a heterozygous mutation c.939delT causing a T base deletion at position 939 in exon 9 of the GNAS gene. The blood PTH level was found to increase in the second patient after 1-year follow-up. Both the patients were confirmedly diagnosed with PHPⅠa. After treatment with vitamin D3, no new skin nodules occurred, and the blood calcium and phosphorus levels returned to normal. Key words: Pseudohypoparathyroidism; Cholecalciferol; DNA mutational analysis; Skin manifestations; GNAS gene

A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

Evaluation of chamomile oil and nanoemulgels as a promising treatment option for atopic dermatitis induced in rats

ABSTRACTBackground: Atopic dermatitis is a chronic inflammatory skin disease that remarkably affects the quality-of-life of patients. Chamomile oil is used to treat skin inflammations. We evaluated the efficacy of chamomile oil and nanoemulgel formulations as a natural alternative therapeutic option for atopic dermatitis.Research design and methods: Formulations were developed comprising chamomile oil: olive oil (1:1), Tween 20/80 or Gelucire 44/14 as surfactant-cosurfactant mixtures, propylene glycol (10%w/w), water and hydroxypropyl methylcellulose (3%w/w). In-vitro physicochemical characterization, stability testing and in-vivo assessment of inflammatory biomarkers and histopathological examination of skin lesions were conducted in rats induced with atopic dermatitis.Results: Nanoemulgels G1 and X1 which displayed the smallest particle size of 137.5 ± 2.04 and 207.1 ± 5.44 nm, good homogeneity and high zeta-potential values of –26.4 and –32.7 mV were selected as the optimized emulgel. Nanoemulgels were nonirritating of pH value 5.56, readily spreadable, and were physically stable following 10 heating-cooling cycles. Treatment with nanoemulgels showed a two-fold decrease in duration of skin healing and no spongiosis compared to chamomile oil. Levels of biomarkers were reduced after topical application of both nanoemulgels and chamomile oil.Conclusion: Nanoemulgels are a potential cost effective, safe topical carrier system for chamomile in treating atopic dermatitis.

丘疹性弹性纤维离解22例临床病理分析

Objective To analyze clinical and pathological features of papular elastorrhexis. Methods Clinical data were collected from 22 patients with confirmed papular elastorrhexis in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from September 2006 to May 2018. Clinical manifestations, pathological findings and follow-up results were retrospectively analyzed. Results The average age of onset of the 22 patients was 5.7 years (range: 1 - 10 years) , and the male to female ratio was 4.5∶1. The average duration from the occurrence of disease to the confirmation of diagnosis was 1.5 years, and no definite etiology was found. The patients had no itching or pain sensation. Skin lesions were soft, slightly elevated, well-circumscribed, round, oval or polygonal-shaped, white papules with diameters of 1 - 10 mm, and wrinkles appeared on the surface of the papule when the papule was pushed towards its center. Among the 22 patients, 16 (73%) presented with scattered lesions, 13 (59%) had less than 5 papules, and lesions were located in the trunk in 21 (95%) . Histopathological examination of skin lesions in 8 patients showed no obvious increase of collagen fibers in the superficial and middle dermis, which were normally arranged with slightly widened spaces between them. Elastic fiber staining showed that elastic fibers disappeared or were dissociated focally in the superficial and middle dermis. After confirmed diagnosis, the 22 patients received no treatment. In 18 patients, skin lesions did not continue to expand after onset, and no new skin lesions occurred. Skin lesions were slightly enlarged, but remained steady thereafter in 4 patients. Sixteen patients achieved partial remission. Conclusions Papular elastorrhexis is a rare skin disorder of elastic fibers that occurs predominantly during childhood and adolescence, and its diagnosis relies on clinical manifestations combined with histopathological findings. No special treatment is needed and the prognosis is good. Key words: Elastic tissue; Skin manifestations; Papular elastorrhexis

副银屑病81例临床及病理分析

Objective To analyze clinicopathological features of parapsoriasis. Methods Clinical and pathological data were collected from 81 patients with parapsoriasis in Department of Dermatology, Peking University First Hospital between January 2016 and May 2018, and analyzed retrospectively. Results Among the 81 patients with parapsoriasis, 44 were male and 37 were female, with age ranging from 6 to 77 years. Their disease course ranged from 7 days to 30 years, and the median disease course was 12 months. Moreover, 61 (75.3%) patients were aged less than 40 years, and 20 (24.7%) were aged 41 years and older. Of the 81 patients, 16 (19.8%) were diagnosed with small plaque parapsoriasis, 20 (24.7%) with large plaque parapsoriasis, 37 (45.7%) with pityriasis lichenoides chronica, and 8 (9.9%) with pityriasis lichenoides et varioliformis acuta. Additionally, distribution patterns of lesions included diffuse type in 65 cases (80.2%) , central type in 6 cases (7.4%) , and peripheral type in 10 cases (12.3%) . Histopathological examination of skin lesions revealed liquefaction degeneration of basal cells in 69 cases (85.2%) , migration of lymphocytes into the epidermis in 67 cases (82.7%) , focal parakeratosis in 42 cases (51.9%) , keratinocyte necrosis in 29 cases (35.8%) , extravasation of erythrocytes in 23 cases (28.4%) , epidermal spongiosis in 21 cases (25.9%) , and dermal perivascular focal infiltration in 61 cases (75.3%) . Conclusion Parapsoriasis has characteristic clinical and pathological manifestations, and a close combination of clinical manifestations with pathological features is necessary for its accurate diagnosis. Key words: Parapsoriasis; Pityriasis lichenoides

Characterization of a novel rhabdovirus isolated from a stranded harbour porpoise (Phocoena phocoena)

An adult male harbour porpoise (Phocoena phocoena) stranded off the coast of Alaska displaying poor body condition, scattered mild ulcerative dermatitis, and necrotizing balanoposthitis. Necropsy findings included severe verminous panniculitis, pneumonia, hepatitis, and enteritis. Histopathological examination of skin lesions revealed a pustular epidermitis and dermatitis, with ballooning degeneration of keratinocytes and occasional amphophilic intracytoplasmic inclusion bodies. A swab sample collected from the ulcerative penile lesions was processed for virus isolation resulting in cytopathic effects observed in primary beluga whale kidney (BWK) cells. Transmission electron microscopy revealed bullet-shaped virions budding from the cell surface of infected BWK cells consistent with a rhabdovirus. A cDNA library was prepared using RNA extracted from infected cell culture supernatant and sequenced on an Illumina MiSeq sequencer. The near-complete genome of a novel rhabdovirus was recovered. Genetic and phylogenetic analyses based on the complete L gene supported the harbour porpoise rhabdovirus (HPRV) as a new species. HPRV clustered phylogenetically with dolphin rhabdovirus (DRV) and this cetacean rhabdovirus clade was found to be the sister group to members of the genus Perhabdovirus that infect fish. A specific nested RT-PCR assay detected HPRV RNA in the epaxial musculature of the harbour porpoise. Our results are consistent with a previous hypothesis that cetacean rhabdoviruses may have arisen following a host jump from fish and suggest that DRV and HPRV represent separate species belonging in a new genus within the family Rhabdoviridae. Further research is needed to determine the health impact of HPRV in harbour porpoise populations, its prevalence, and route of transmission.

Acute generalized exanthematous pustulosis caused by lincomycin: a case report

A 28-year-old male patient with coughing was treated with intramuscular injection of lincomycin, oral Kesouting granules and erythromycin in a local clinic. One day later, erythema occurred on the head and face, and rapidly spread to the trunk and limbs. Three days later, a large number of densely distributed needle tip- to millet-sized pustules occurred on the generalized erythema all over the body with fever and burning pain sensation of the skin. Skin examination revealed diffuse edematous erythema with obvious hyperemia on more than 90% of the body, a large number of needle tip- to millet-sized white-yellowish pustules on the erythema on the hair line, face, flexor aspect of the extremities and flexural site of the trunk (axillary and inguinal regions) , and bilateral lower-extremity swelling. No erythema or erosion was observed on the oral mucosa or genital mucosa. Histopathological examination of skin lesions on the right elbow showed local intraepidermal and subcorneal pustules, necrotic keratinocytes and neutrophil aggregation in the pustules, and infiltration of lymphocytes and eosinophils in the superficial dermis. Laboratory examination showed elevated white blood cell counts (26.9 × 109/L) , neutrophils proportion (Segment, 0.88) , C-reactive protein level (127.89 mg/L) , aspartate aminotransferase level (44.2 U/L) and alanine transarninase level (77.3 U/L) , but decreased proportion of lymphocytes (0.08) . The patient was diagnosed with acute generalized exanthematous pustulosis. After admission, the patient was treated with intravenous drips of methylprednisolone at a dose of 60 mg/d. Then, the condition was rapidly relieved, and the dosage was rapidly reduced. The patient was discharged on day 7. Key words: Acute generalized exanthematous pustulosis; Lincomycin; Drug eruptions; Drug-induced liver injury

Evaluation of Fluorescent Staining for Diagnosis of Leprosy and its Impact on Grading of the Disease: Comparison with Conventional Staining.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). Histopathological examination of skin lesion is the gold standard for diagnosis. We evaluated the possible role of fluorescent microscopy in this direction which is increasingly used for rapid screening. To compare the efficacy of auramine rhodamine stain with Ziehl-Neelsen and modified Fite-faraco staining in diagnosing M. leprae in tissue sections. Experimental, cross-sectional and retrospective study conducted for 4 years. Skin biopsies of sixty clinically diagnosed leprosy patients were stained by Ziehl-Neelsen, Fite-Faraco and fluorescent stain. The presence of the bacilli and the bacillary index was scored for each case. The bacillary index by each staining methods were compared. SPSS v 17 (IBM, New York) used for data analysis. Chi-Square test was used to calculate significance between differences. The p-value of <0.05 was considered as statistically significant. Pearson Correlation (r-value determined) was also used for comparison between groups. Sensitivity of fluorescent stain for indeterminate and borderline tuberculoid leprosies were 100% each. Positivity rates and mean bacteriological index with fluorescent stain was higher (43.3 and 11.5 respectively) as compared to that of Ziehl- Neelsen and Fite-faraco when the bacillary load was less (bacillary index < 3). There was significant correlation between the three staining types at higher bacillary load. There was a higher mean bacillary index with fluorescent stain as well as detection of an additional multibacillary case. Fluorescent method is more sensitive than modified fite-faraco method in detecting lepra bacilli in tissue sections especially in cases with bacillary index less than three. With its higher sensitivity, paucibacillary cases could be upgraded to multibacillary thus affecting treatement decisions.

Mantle cell lymphoma with skin involvement: a case report

A 51-year-old female patient, who had been diagnosed with mantle cell lymphoma for 20 months, was admitted to the hospital for erythematous nodules on extremities for 10 days. Physical examination showed left cervical and submaxillary lymphadenectasis as well as bilateral enlarged palatine tonsils (grade Ⅱ) . Histopatholo-gical examination of skin lesions on the left upper limb revealed diffuse infiltration of small lymphocytes in dermis and subcutaneous tissue. Immunohistochemical examination showed positive staining for CD5, Bcl-2, CD43, CD20, CyclinD1, λ chain and Ki-67 (> 70 %) , but negative staining for CD3, C10, Bcl-6, CD23, CD21 and κ chain. Fluorescence in situ hybridization (FISH) showed the absence of the t (11:14) /CCND1-IGH fusion gene. The patient was diagnosed as mantle cell lymphoma with skin involvement. After treatment with cyclophosphamide, doxorubicin, vincristine and prednisone, the condition was controlled and follow up was underway. Key words: Lymphoma, mantle-cell; Skin diseases; Rare diseases

Co‐infection of molluscum contagiosum virus and cryptococcosis in the same skin lesion in a HIV‐infected patient

A young human immunodeficiency virus-infected man was admitted in unconsciousness state. Few papular skin lesions resembling molluscum contagiosum (MC) were present on the face. He was found to have cryptococcal meningitis using India ink preparation of cerebrospinal fluid. Histopathological examination of skin lesion revealed the presence of capsulated yeast forms of Cryptococcus within the lesion of MC. The co-existence of MC and cryptococcosis in the same cutaneous lesion is rare, and it could be because of immunosuppression (low CD4 count).

Primary systemic amyloidosis

Systemic amyloidosis is a rare disorder which usually occurs in aged persons and has a poor prognosis. Systemic amyloidosis can be primary, occasionally associated with multiple myeloma, or secondary, associated with another disease. We presented a 72-year-old male patient with periocular purpura ("racoon sign") and waxy papules, petechiae and ecchymoses on the neck and thoracic area. Purpuric macules were present also on the lips and tongue which was edematous (macroglossia). The skin lesions occurred two years earlier, the patient lost more than 15 kilograms of the body mass for less than a year. Immunoelectrophoresis of urine and serum demonstrated the presence of immunoglobulin light chains of the circulating monoclonal protein. Histopathological examination of skin lesions showed Congo red positive deposits in the derm. Cardiac evaluation revealed the signs of heart failure, and renal evaluation revealed nephrotic syndrome, with excessive protein lost. He was treated with oral melphalan and prednisolone, and died 7 days after starting the therapy due to heart failure. This patient considered as a rare case with systemic amyloidosis highlights the importance of histopathological and physical examination in any cases with periocular purpura, petechiae, ecchymoses and macroglossia.

Cutaneous Rosai-Dorfman disease

Sinus histiocytosis with massive lymphadenopathy, or Rosai-Dorfman disease, is a benign idiopathic histiocytic proliferative disorder that commonly involves the lymph nodes but secondarily may involve the skin. However, purely cutaneous disease without lymphadenopathy or internal organ involvement rarely may occur. We present case reports of three patients who presented with asymptomatic nonspecific enlarging skin nodules without evidence of lymphadenopathy or internal disease. Histopathologic examination of skin lesions in all patients showed proliferation of large histiocytes with phagocytosed inflammatory cells characteristic of Rosai-Dorfman disease. However, the diagnoses of dermatofibroma, other spindle cell neoplasm, infectious granulomatous process, and other xanthohistiocytic proliferations were also considered due to the presence of storiform spindle cells and foamy cells in the first case. One patient experienced regression during a course of oral steroids, while another patient cleared spontaneously. In the absence of massive lymphadenopathy characteristic of Rosai-Dorfman disease, the diagnosis of purely cutaneous Rosai-Dorfman disease may be complicated by the rarity, non-specific clinical appearance of skin lesions, and broad histopathological differential diagnosis of this disorder. A high index of suspicion of the clinician and pathologist is often required.

Cutaneous sarcoidosis in Asians: a report of 25 patients from Singapore

Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin involving multiple organ systems. There has been no report so far to describe the epidemiological pattern of cutaneous involvement in sarcoidosis in South-East Asia with diverse ethnic groups. A retrospective study examining the clinicopathological features of all patients diagnosed with sarcoidosis at a tertiary dermatology centre in Singapore from 1980 to 2003 was conducted. Cutaneous sarcoidosis was diagnosed in 25 patients: 13 were Indian, 11 were Chinese and one was Eurasian. Cutaneous manifestations included papules, nodules, plaques and scarring alopecia. Extracutaneous involvement of lymph nodes (four patients), lungs (eight patients) and eyes (two patients) was seen. Eight patients had abnormal chest radiographic findings. Histopathological examination of skin lesions revealed noncaseating, epithelioid granulomatous infiltration in the dermis without evidence of mycobacterial infection, deep fungal infection or polarizable birefringent material. Treatment modalities included corticosteroids, hydroxychloroquine, isotretinoin, methotrexate and surgical excision. Five patients had complete resolution of the cutaneous lesions. Cutaneous sarcoidosis is rare in Asia and indeed in Singapore. Extracutaneous involvement is not uncommon and a thorough clinical evaluation should be undertaken.

Photoallergic reaction to fluorescein

A photoallergic reaction to fluorescein was demonstrated in a male diabetic by photopatch and photoprovocation tests. Sensitization was acquired by tonometries using a fluorescein-containing local anesthetic, preceding fluorescein angiography for diagnosis of diabetic retinopathy. Histopathological examination of skin lesions induced in both photopatch and photoprovocation tests confirmed the diagnosis of photoallergic reaction to fluorescein.

Factors Limiting the Usefulness of Histopathologic Examination of Skin Biopsies in the Diagnosis of Large Animal Dermatoses

Skin biopsy for histologic, immunofluorescent, parasitologic, and bacteriologic examination is a common procedure, but for maximum effectiveness the clinician must realize the importance of precautions to select the correct stage of lesion of different diseases; avoiding creating artifacts during removal and fixation; and give full details of history, clinical diagnosis, and differential diagnoses on the laboratory request sheet. Pathology reports describing the subtleties of histologic changes are difficult to write, particularly if the lesions are not specific. Overly long histologic reports without a definitive diagnosis may frustrate a clinician who is unfamiliar with the significance of histologic lesions. For these reasons, clinician and pathologist must develop a rapport and empathy for the other's difficulties and adequately communicate to allow each to make a maximum contribution toward the final diagnosis. Histopathologic examination of skin lesions may not produce a specific diagnosis but is frequently useful in the elimination of other suspected diagnoses.