Sotto M N, Yamashiro-Kanashiro E H, da Matta V L, de Brito T
Department of Pathology, Hospital das Clinicas (Dermatologic Division), Sao Paulo, Brazil.
Acta Trop. 1989 Mar;46(2):121-30. doi: 10.1016/0001-706x(89)90006-5.
Non-specific chronic inflammation and/or granulomatous reaction are the main histopathological manifestations of cutaneous and mucocutaneous leishmaniasis of the New World. Plasma cell infiltration associated with collagen and vascular changes are data suggestive but not diagnostic of the disease. Specific diagnosis is only possible through demonstration of the parasite in the tissue examined. It is noteworthy that the parasites are usually scanty and difficult to demonstrate in the lesions. Biopsies from 40 patients with cutaneous or mucocutaneous leishmaniasis were examined using the immunofluorescence and immunoperoxidase techniques in order to demonstrate the parasite and/or antigen in the tissues. Nineteen biopsies showed non-specific chronic inflammation and 21 a granulomatous reaction. Parasites were found in 20% of the routine biopsies. The positivity through indirect immunofluorescence was 88.46% in frozen sections of fresh material and 89.28% in paraffin embedded tissue. The antigen positivity with the immunoperoxidase technique was 64.51%. Antigen was detected as amastigotes and also as diffuse material in the macrophage cytoplasm and adsorbed in the epithelial basement membrane and vessel walls. There was no difference in the positivity of antigen according to the type of inflammatory reaction.
非特异性慢性炎症和/或肉芽肿反应是新大陆皮肤和黏膜皮肤利什曼病的主要组织病理学表现。与胶原和血管变化相关的浆细胞浸润提示但不能诊断该病。只有通过在所检查的组织中发现寄生虫才能进行特异性诊断。值得注意的是，病变中的寄生虫通常很少且难以发现。为了在组织中显示寄生虫和/或抗原，对40例皮肤或黏膜皮肤利什曼病患者的活检标本采用免疫荧光和免疫过氧化物酶技术进行检查。19份活检标本显示非特异性慢性炎症，21份显示肉芽肿反应。在20%的常规活检标本中发现了寄生虫。新鲜材料冰冻切片间接免疫荧光阳性率为88.46%，石蜡包埋组织为89.28%。免疫过氧化物酶技术检测抗原阳性率为64.51%。抗原以无鞭毛体形式以及巨噬细胞胞质中的弥漫性物质形式被检测到，并吸附在上皮基底膜和血管壁上。根据炎症反应类型，抗原阳性率没有差异。
