Clinical, Histopathologic, and Cytologic Diagnosis of Mucosal Leishmaniasis and Literature Review

Abstract

Context.—Mucosal leishmaniasis (ML) is a rare disease in the world, even in endemic areas such as Iran. Clinical, histologic, or cytologic assessment may help in the diagnosis of ML. Objective.—To describe clinical, histologic, and cytologic findings in ML. Design.—Review of our files showed 11 patients diagnosed with ML, of whom 7 patients had oral lesions, 1 of whom was a known patient with oral leishmaniasis with recurrence of oral lesions; 2 had laryngeal lesions; and 3 had nasal lesions. One case of laryngeal leishmaniasis was a recurrence of prior oral lesions. Cytologic smears were prepared by scraping the lesions with a scalpel or cytobrush. Histology on the biopsies was done for 7 patients. In 2 patients with nasal lesions, exfoliative cytology was made by washing the nasal cavity. Smears were both air dried and fixed in alcohol and stained. Results.—Cytologic findings showed free Leishman-Donovan bodies, intrahistiocytic Leishman-Donovan bodies, atypical organisms, granuloma, acute and chronic inflammatory cells, histiocytes, multinucleated giant cells, mast cells, binucleated histiocytes (Reed-Sternberg–like cells), and plasma cells. In 6 of the patients, biopsy was inconclusive and in subsequent cytology the organism was detected. In 3 cases, findings from clinical and cytologic examinations were suggestive for leishmaniasis; however, with response to treatment, the diagnosis was confirmed. In 5 patients a malignant tumor was suspected because of clinical or histologic findings, but cytology helped to diagnose leishmaniasis. Conclusions.—Clinically or histologically, ML can be mistaken for benign and malignant lesions. Scraping or exfoliative cytology is an easy, reliable, and cost-effective method for diagnosing ML. Thus, clinical, histologic, and cytologic features together may help in ML diagnosis.

Laboratory diagnostics for human Leishmania infections: a polymerase chain reaction-focussed review of detection and identification methods

“…Histological examination does, however, depend upon the disease stage, since the number of amastigotes decreases as CL progresses until they are undetectable [ 62 ]. Indeed, it is considered the least sensitive diagnostic method, with sensitivities of between 42.0% and 70.0%, although 100% specificity has been reported [ 79 – 81 ]. Furthermore, Leishmania cells may be mistakenly identified in histological sections as Toxoplasma gondii , Mycobacterium leprae , fungi, including Histoplasma , or even artifacts, and differential diagnosis requires alternative stains [ 81 – 84 ].…”

Mucosal Leishmaniasis Involving the Nostril and Maxillary Sinus: A Case Report

“…Sinonasal involvement in ML cases presented with stuffiness of the nose, inflammation, edema, serous rhinorrhea, and epistaxis that may progress to dysphagia and dysphonia. Diffuse mucosal involvement of the oropharyngeal and sinonasal areas may easily spread to the lower respiratory tract [20,22,24,26,27].…”

“…In the present case, the child presented with nasal discharge for two years and difficulty in breathing for one year, and clinical examination revealed whitish polypoid swelling in the background of the inflammatory nasal mucosa of the left nostril with peripheral crustation without any cutaneous lesions on facial or upper or lower limb region. Histopathological examination revealed Leishmania amastigote in the mucosal lesions on Giemsa and hematoxylin and eosin (H&E) staining [27].…”

Parasites causing cutaneous wounds: Theory and practice from a dermatological point of view

“…MCL is a destructive disease that affects the mucous membranes of the mouth, nose, pharynx, and larynx (Daneshbod et al, 2011). This form typically starts at the lips or the nostrils and can potentially lead to permanent disfigurement and be life-threatening (Burza et al, 2018).…”