Day Tania, Borbolla Foster Ailsa, Phillips Samuel, Pagano Ross, Dyall-Smith Delwyn, Scurry James, Garland Suzanne M
1Maternity and Gynaecology, John Hunter Hospital; and 2Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales; 3Department of Microbiology and Infectious Diseases Laboratory Services, Murdoch Children's Research Institute, Parkville; and 4Vulvar Disorders and Dermatology Clinic, Royal Women's Hospital, Melbourne; 5Riverina Dermatology, Wagga Wagga; and 6Anatomical Pathology, Pathology North, Hunter New England, Newcastle, New South Wales; and 7Faculty of Medicine, Dentistry, and Health, University of Melbourne, Parkville, Victoria, Australia.
J Low Genit Tract Dis. 2016 Jul;20(3):267-71. doi: 10.1097/LGT.0000000000000208.
This study aimed to determine if vulvar cutaneous candidosis and dermatophytosis can be distinguished by routine histopathology.
Twenty-four cases of periodic acid-Schiff-stained vulvar biopsies with a diagnosis of cutaneous mycosis were reviewed and histopathological characteristics on both periodic acid-Schiff and hematoxylin and eosin were recorded. Data were collected on age, clinical impression, microbiological results, and treatment, and all specimens underwent multiplex polymerase chain reaction analysis.
The mean age was 60 years, and all but 3 women had at least 1 risk factor for mycosis including 15 (62.5%) with lichen sclerosus and/or planus managed with topical corticosteroids. A clinical suspicion of tinea or candidosis was documented in 12 (50%) of the cases. Vulvovaginal swabs showed Candida species in 9 women; one skin scraping was positive for Trichophyton rubrum. Microbiology was not obtained in 8 patients, 5 had a negative swab, and 1 had negative skin scrapings. No histopathological or morphological features distinguished Candida species from dermatophytes. Organisms appeared as basophilic structures in the stratum corneum in 15 (62.5%) hematoxylin and eosin-stained slides. Polymerase chain reaction results were positive for Candida species in 5 (21%) and for dermatophytes in 3 (13%), negative in 13, and unassessable in 3 cases.
Vulvar cutaneous candidosis and dermatophytosis cannot be reliably distinguished by routine histopathology or specific polymerase chain reaction. A high index of suspicion combined with adequate microbiological testing remains the best approach to differentiating between the 2, which impacts on counseling, treatment, and prognosis.
本研究旨在确定外阴皮肤念珠菌病和皮肤癣菌病是否可通过常规组织病理学进行区分。
回顾了24例经高碘酸-希夫染色诊断为皮肤真菌病的外阴活检病例，并记录了高碘酸-希夫染色及苏木精和伊红染色的组织病理学特征。收集了年龄、临床诊断、微生物学结果及治疗方面的数据，所有标本均进行了多重聚合酶链反应分析。
平均年龄为60岁，除3名女性外，所有女性均至少有1项真菌病危险因素，其中15例（62.5%）患有硬化性苔藓和/或扁平苔藓，接受局部皮质类固醇治疗。12例（50%）病例有临床怀疑股癣或念珠菌病。9名女性的外阴阴道拭子显示有念珠菌属；1份皮肤刮屑红色毛癣菌检测呈阳性。8例患者未获得微生物学检测结果，5例拭子检测为阴性，1例皮肤刮屑检测为阴性。没有组织病理学或形态学特征能够区分念珠菌属和皮肤癣菌。在15张（62.5%）苏木精和伊红染色切片中，病原体在角质层呈嗜碱性结构。聚合酶链反应结果显示，5例（21%）念珠菌属阳性，3例（13%）皮肤癣菌阳性，13例阴性，3例无法评估。
外阴皮肤念珠菌病和皮肤癣菌病无法通过常规组织病理学或特异性聚合酶链反应可靠区分。高度怀疑并结合充分的微生物学检测仍是区分两者的最佳方法，这对咨询、治疗及预后均有影响。
