Quintella Leonardo Pereira, Passos Sonia Regina Lambert, do Vale Antônio Carlos Francesconi, Galhardo Maria Clara Gutierrez, Barros Monica Bastos De Lima, Cuzzi Tullia, Reis Rosani Dos Santos, de Carvalho Maria Helena Galdino Figueiredo, Zappa Mônica Barbato, Schubach Armando De Oliveira
Serviço de Anatomia Patológica, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
J Cutan Pathol. 2011 Jan;38(1):25-32. doi: 10.1111/j.1600-0560.2010.01626.x. Epub 2010 Sep 30.
Sporotrichosis is the most common subcutaneous mycosis in Rio de Janeiro. Histopathological examination reveals diffuse granulomatous and suppurative dermatitis, and the fungus is rarely identifiable in tissue. We describe the histopathological features of cutaneous sporotrichosis, and investigate the association between them and the lack of visualization of the fungus.
A total of 119 samples of confirmed sporotrichosis cases were studied. The characteristics of the inflammatory infiltrate, the presence of epidermal changes, necrosis and fibrosis, and the parasite burden were analyzed. The association between histopathological changes and the lack of visualization of the fungus was evaluated using prevalence ratios.
Granulomas were observed in all samples, suppurative granulomas in 100 (84%) and diffuse dermatitis in 114 (95.8%). Liquefaction and caseous necrosis were present in 78 (65.5%) and 52 (43.7%) samples, respectively. The fungus was not seen in 77 (64.7%) samples. Epithelioid, tuberculoid or foreign-body-type granulomas, caseous, fibrinoid or absent necrosis, predominance of lymphocytes among nonphagocytic cells and fibrosis were associated with the lack of visualization of the fungus.
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.
孢子丝菌病是里约热内卢最常见的皮下真菌病。组织病理学检查显示为弥漫性肉芽肿性和化脓性皮炎，且在组织中很少能识别出真菌。我们描述了皮肤孢子丝菌病的组织病理学特征，并研究了它们与真菌无法可视化之间的关联。
共研究了119例确诊的孢子丝菌病病例样本。分析了炎性浸润的特征、表皮变化、坏死和纤维化的存在情况以及寄生虫负荷。使用患病率比评估组织病理学变化与真菌无法可视化之间的关联。
所有样本中均观察到肉芽肿，100例（84%）出现化脓性肉芽肿，114例（95.8%）出现弥漫性皮炎。分别有78例（65.5%）和52例（43.7%）样本存在液化和干酪样坏死。77例（64.7%）样本中未见到真菌。上皮样、结核样或异物型肉芽肿、干酪样、纤维蛋白样或无坏死、非吞噬细胞中淋巴细胞占优势以及纤维化与真菌无法可视化有关。
当未见到致病真菌时，孢子丝菌病的组织病理学特征存在差异。在适当的情况下，即使没有可证实的酵母，孢子丝菌病的诊断仍是一个潜在的考虑因素。
