Histopathology of cutaneous sporotrichosis in Rio de Janeiro: a series of 119 consecutive cases

Abstract

The histopathological characteristics of sporotrichosis were variable when the causative fungus was not seen. In a proper context, the diagnosis of sporotrichosis remains a potential consideration even in the absence of demonstrable yeast.

Sporothrix schenckii and Sporotrichosis

“…When the fungus is not in evidence, suppurative granulomas, neutrophils, and liquefaction necrosis are uncommon (187).…”

New Diagnostic Applications in Sporotrichosis

“…Splendore first observed this structure in 1908 on tissue sections from patients with sporotrichosis and afterwards by Hoeppli in 1932 around schistosome larvae (Kwon-Chung & Bennett, 1992). Positive identification of this structure in tissue sections from patients with sporotrichosis ranges from 20% to 66% (Gezuele & Rosa, 2005); although other authors reported that this structure was not observed in several analysed samples (Quintella et al, 2011). These histopathologic findings help to differentiate sporotrichosis from other diseases.…”

“…The presence or predominance of epithelioid granulomas, caseous/fibrinoid necrosis and fibrosis as well as the occurrence of foreign body granulomas with predominance of lymphocytes is related to a lack of fungal observation. Suppurative granulomas, neutrophils and liquefaction are more common when S. schenckii yeast-like cells are encountered (Quintella et al, 2011). Several authors observed the Splendore-Hoeppli reaction on histopathologic tissue sections from sporotrichosis patients.…”

“…Moreover, hyperkeratosis, parakeratosis and pseudoepitheliomatous hyperplasia may also occur (Larone, 2002). In addition to intact polymorphonuclear cells, the granuloma formed during sporotrichosis may also contain cellular debris, caseous material, lymphocytes, plasmocytes, giant and epithelioid cells, fibroblasts and yeasts (Quintella et al, 2011). Some authors also report that foreign material of vegetal origin related to the traumatic inoculation of the agent may be found in rare cases (Orellana et al, 2009).…”

“…Although S. schenckii yeast-like cells may be seen in skin biopsies with the routinely used hematoxylin and eosin (H&E) stains, other stains such as Gomori methenamine silver (GMS) or periodic acid-Schiff (PAS) can be used to confirm identification of fungal elements ( Figure 7A). Parasitic cells of S. schenckii, which can be found within phagocitic cells or in the extracellular space, are difficult to see due to the paucity of these cells in lesions from human patients (Larone, 2002;Quintella et al, 2011). The reaction of the tissue is another important characteristic that should be evaluated during histopathologic examination of skin biopsies during diagnosis of sporotrichosis.…”