[492] Cutaneous Leishmaniasis Mimicking Other Inflammatory and Neoplastic Processes: A Study of 54 Cases.

Ibrahim Khalifeh, Faysal Fedda. American Univeristy of Beirut, Lebanon

Background: Cutaneous leishmaniasis (CL) displays a considerable variation in the histological and clinical pattern. Clinically, CL presents as an erythematous papule that enlarges over the course of few weeks into painless ulcerated and crusted nodule/plaque. Histologically, the acute lesion displays sheets of histiocytes packed with amastigotes followed by granulomatous inflammation and scarring.
Design: After reviewing all the cases in our files (122 cases from 1992-2010) designated with the diagnosis of CL, 54 cases showed histological impression (HI) other then CL. Seven sections (4µm in thickness) from each formalin fixed paraffin embedded skin biopsy FFPE were stained: 3 H & E, 1 Giemsa, 1 AFB, 1 GMS, and 1 PAS. In cases with no unequivocal amastigotes identified, the diagnosis of CL was confirmed by PCR using primers specific for the Leishmania ribosomal internal transcribed spacer 1 (ITS1-PCR). The per-biopsy clinical diagnosis (PCD) of all 54 cases was collected.
Results: Out of the 54 cases, 20 cases presented with PCD other then CL. The PCD ranges from inflammatory dermatiditis to neoplastic processes and those included: deep fungal infection (DFI), sarcoidosis (SA), lupus (LE), mycobacterial infection (MI), Basal cell (BCC)/Squamous cell (SCC) carcinoma and lymphoma/pseudolymphoma (LY). The HI was recorded.

HI and PCD distribution.
 HI #PCD #
PLEVA: pityriasis lichenoides; SS: secondary syphilis; LP: lichen planus; SASD: subacute pongiotic dermatitis; PA: paniculitis; FDE: fixed drug eruption; DF: dermatofibroma; LE: lupus.

Confirmation of the diagnosis by PCR was performed on 32 cases (58%) where no unequivocal amastigotes were identified.
Conclusions: The manifestations associated with CL are broad both clinically and histologically. Pathologist should be aware of such pitfalls especially in endemic areas.
Category: Dermatopathology

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 131, Wednesday Afternoon


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