Utino Fabiane Leonel, Damiani Gislaine Vieira, Garcia Marina, Soares Tânia Cristina Benetti, Stelini Rafael Fantelli, Velho Paulo Eduardo Neves Ferreira, de Souza Elemir Macedo, Cintra Maria Letícia
Pathology Department, University of Campinas (UNICAMP), Campinas, Brazil.
Dermatology Department, University of Campinas (UNICAMP), Campinas, Brazil.
J Cutan Pathol. 2018 Feb;45(2):111-117. doi: 10.1111/cup.13064. Epub 2017 Dec 5.
More than 200 000 new cases of leprosy are detected worldwide annually. Physicians commonly have difficulty in differentiating tuberculoid form of leprosy (TL) from sarcoidosis' cutaneous manifestation.
Skin biopsies of 33 patients with TL and 24 with sarcoidosis were reviewed on hematoxylin and eosin- and Gomori-stained sections, in order to find reliable criteria for distinguishing one disease from another.
Nine of the 24 features analyzed presented significant predictive value for diagnosis (P < .05). Predominance of tuberculoid granulomas in adnexal and neural distribution, and granulomas replacing the nerves localized within sweat gland glomeruli were predictive to TL diagnosis. For sarcoidosis, dermal fibrosis, back-to-back distribution of the granulomas, presence of atypical giant cells and plasma cells, greater number of conventional giant cells, and spared nerves beside the granuloma were predictive criteria. The median surface density of reticulin fibers was significantly higher in sarcoidosis (3.44) than in TL (2.99). Nonetheless, using logistic regression, this variable did not discriminate between the diseases (P = .096).
Isolated histological features are not fully predictive to differentiate the 2 diseases. However, those with statistical value can assist this distinction in diagnostic practice. Although the results of the analysis of the reticulin fibers density did not tell apart TL from sarcoidosis, they corroborate the idea of fiber fragmentation within tuberculoid leprosy granulomas, reiterating the importance of morphometry in the histological examination.
全球每年检测到超过20万例新的麻风病例。医生通常难以区分结核样型麻风（TL）和结节病的皮肤表现。
对33例TL患者和24例结节病患者的皮肤活检标本进行苏木精-伊红染色和戈莫里染色切片检查，以寻找区分这两种疾病的可靠标准。
分析的24项特征中有9项对诊断具有显著预测价值（P <.05）。附属器和神经分布中结核样肉芽肿占优势，以及肉芽肿取代位于汗腺小球内的神经，对TL诊断具有预测性。对于结节病，真皮纤维化、肉芽肿背靠背分布、非典型巨细胞和浆细胞的存在、传统巨细胞数量较多以及肉芽肿旁神经未受累是预测标准。结节病中网状纤维的中位表面密度（3.44）显著高于TL（2.99）。然而，使用逻辑回归分析，该变量并不能区分这两种疾病（P = 0.096）。
单一的组织学特征不能完全预测区分这两种疾病。然而，具有统计学价值的特征可在诊断实践中辅助这种区分。尽管网状纤维密度分析结果未能区分TL和结节病，但它们证实了结核样麻风肉芽肿内纤维断裂的观点，重申了形态计量学在组织学检查中的重要性。
