Grover Sumit, Agale Shubhangi Vinayak, D'Costa Grace F, Valand Arvind G, Gupta Vikram Kumar
Assistant Professor, Department of Pathology, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
Associate Professor, Department of Pathology, Govt. Grant Medical College , Mumbai, India .
J Clin Diagn Res. 2016 Apr;10(4):EC10-4. doi: 10.7860/JCDR/2016/16459.7568. Epub 2016 Apr 1.
Infectious Granulomatous Dermatoses (IGDS) have various aetiological factors with a considerable overlap in the histopathological and clinical features, thus posing a diagnostic dilemma for dermatologists and pathologists.
We aimed at determining the histopathological profile of IGDS correlating it with clinical features with an attempt to find the aetiology.
In a cross-sectional study conducted in a tertiary referral center of Mumbai over two years, out of 1872 skin biopsies received, 239 histopathologically diagnosed cases of IGDS were studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Chi-square test was used for comparison of proportions of different groups.
Leprosy (211 cases) and tuberculosis (28 cases) were the commonest histopathologically diagnosed IGDS. Leprosy spectrum included BT (30.33% cases), followed by TT (21.32%), BL and LL and 21.79% cases of lepra reactions. Skin TB biopsies on histopathology showed lupus vulgaris (53.85% cases), scrofuloderma (15.38%), TBVC and papulonecrotic tuberculid (11.54% each). In leprosy maximum clinico-pathological agreement was seen at tuberculoid pole (TT 72.7% and BT 56.6%). Among tuberculosis cases, scrofuloderma (100%) and lupus vulgaris (53.8%) showed maximum agreement.
Leprosy and skin TB are the commonest IGDS in Mumbai region though difficult to diagnose and subcategorize with certainty during initial stages. Histopathology plays the important role to elucidate the dilemma. This being a single center study, more such studies with a larger sample size are recommended to get more elaborate data and regional prevalence of these IGDS for a better overall approach to prevention, treatment and control.
感染性肉芽肿性皮肤病（IGDS）有多种病因，其组织病理学和临床特征有相当大的重叠，因此给皮肤科医生和病理学家带来了诊断难题。
我们旨在确定IGDS的组织病理学特征，并将其与临床特征相关联，试图找出病因。
在孟买一家三级转诊中心进行了一项为期两年的横断面研究，在收到的1872份皮肤活检标本中，对239例经组织病理学诊断为IGDS的病例进行了肉芽肿组织病理学特征研究。尝试进行临床-组织病理学相关性分析。采用卡方检验比较不同组的比例。
麻风（211例）和结核（28例）是组织病理学诊断最常见的IGDS。麻风谱系包括BT（30.33%的病例），其次是TT（21.32%）、BL和LL以及21.79%的麻风反应病例。皮肤结核活检的组织病理学表现为寻常狼疮（53.85%的病例）、瘰疬性皮肤结核（15.38%）、结核性丘疹坏死性皮肤结核和丘疹坏死性结核疹（各11.54%）。在麻风病中，在结核样型极（TT为72.7%，BT为56.6%）观察到最大的临床-病理一致性。在结核病例中，瘰疬性皮肤结核（100%）和寻常狼疮（53.8%）显示出最大的一致性。
在孟买地区，麻风病和皮肤结核是最常见的IGDS，尽管在初始阶段难以确切诊断和细分。组织病理学在阐明这一难题方面起着重要作用。由于这是一项单中心研究，建议开展更多此类样本量更大的研究，以获得更详尽的数据以及这些IGDS的区域患病率，从而采取更好的整体预防、治疗和控制方法。
