Cutaneous Leishmaniasis With Pseudoepitheliomatous Hyperplasia Simulating Squamous Cell Carcinoma

Case Report: Squamous Cell Carcinoma Referred for Mohs Surgery Found to be Cutaneous Leishmaniasis

“…19,20 Particularly, PEH, an unorganized proliferation of keratinocytes toward deeper tissue in response to chronic inflammation, can easily be mistaken as squamous cell carcinoma (Table 1). 8,9 However, SCC is but one cause of this condition and findings such as abundant inflammatory infiltrate, dermal compromise, and absence or limited mitotic activity in the epidermis should prompt investigation of alternative diagnosis. 21,22 This evidence about histopathological characteristics of SCC underscores features of this pathology in the differential diagnosis when faced with lesions compatible with CL.…”

“…However, biopsy can be useful in evaluating other potential etiologies of chronic skin lesions, although it must be recognized that there can be overlap in some findings. 8 Overall, the medical evaluation of a chronic lesion in the skin requires a highly experienced physician who integrates information from the clinical history, laboratory evaluations, and epidemiologic context to make a diagnostic impression. 9,10 We present a case where histopathological findings led to the referral for surgical treatment of a skin lesion as SCC.…”

Cutaneous leishmaniasis mimicking squamous cell carcinoma

“…Classic histopathological findings include dense diffuse infiltrates of lymphocytes, plasma cells, and histiocytes with numerous grey-blue dots of Leishmania in the cytoplasm throughout the reticular dermis [9,11]. However, leishmaniasis is known to present many atypical histopathological features.…”

“…Without visualization of amastigotes, histopathological differentiation between leishmaniasis and other granulomatous skin diseases, malignant processes, cutaneous tuberculosis, and deep mycotic infection can be difficult [12]. Further complicating the diagnosis is the presence of pseudoepitheliomatous squamous hyperplasia, a response to chronic epithelial irritation seen in leishmaniasis, which can simulate SCC [11]. Overall, the sensitivity of histopathologic examination in the diagnosis of leishmaniasis ranges from 16-74% [13].…”

Clinicopathological presentation of cutaneous leishmaniasis and its diagnostic algorithm

“…Başsorgun et al in their study of 28 patients from Turkey in 2015 evaluated the epidermal and dermal changes that would predict the histopathological diagnosis of cutaneous leishmaniasis and found that epidermal thinning/thickening, and orthokeratosis were early stage indicators, while exocytosis, hyperparakeratosis, and epidermal thinning were indicative of late stage disease [18]. Highly unlikely forms of presentation usually show a marked acanthosis or even wide areas of necrosis that can mimic other conditions such as squamous cell carcinoma, deep fungal infection or secondary syphilis, granulomatous lesions (sarcoidal and elastolytic) and simulating lupoid rosacea or granuloma annulare [19,20]. Non specific pathologies which can coexist with cutaneous leishmaniasis include inflammatory diseases (panniculitis, subacute spongiotic dermatitis, lichen planus) or infectious/granulomatous conditions (tuberculosis-like lesions, sarcoidosis, pityriasis lichenoides, indeterminate leprosy), and neoplastic lesions (mycosis, anaplastic T-cell lymphoma).…”