Murry Wonchibeni T, Sharma Sonal, Arora Vinod Kumar, Bhattacharya Sambit Nath, Singal Archana
Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Diagn Cytopathol. 2019 May;47(5):458-468. doi: 10.1002/dc.24138. Epub 2018 Dec 24.
The diagnosis of cutaneous tuberculosis is challenging due to its diverse clinical manifestations, paucibacillary state and lack of proper diagnostic tests. Clinico-pathological correlation is still frequently used for diagnosis. There is paucity of literature on cytomorphological features. Immunochemistry can help as an ancillary test.
Clinical diagnosis was made after thorough history and physical examination. Modified Fine Needle Aspiration technique was used to collect cytology samples and 3 mm punch biopsy for histological examination. Findings on histopathology were compared with cytomorphology. Immunochemical staining with anti-TB polyclonal antibody using standard Polymer-based-HRP immunochemistry technique and comparison of cytology and histology findings.
The morphological spectrum of biopsy and cytology showed high correlation using nine parameters: necrosis, granulomas, giant cells, AFB, neutrophilic infiltrate, presence of lymphocytes, histiocytes, collagen bundles, and immunochemistry. Diagnostic correlation of FNA compared to biopsy was found to be 90.3%. On comparing cytomorphology of scrofuloderma and lupus vulgaris, all the parameters were found more frequently in scrofuloderma except for granulomas, giant cells and immunochemistry. Immunochemistry showed sensitivity and specificity of 90.3% and 70% on biopsy, respectively, compared to 67.7% and 60% on FNA, respectively. Combined sensitivity of IHC and ICC was 96.8%.
The cytomorphological spectrum of cutaneous tuberculosis is comparable to clinicohistopathology with a high correlation of 90.3%. However, sub classification on FNA is difficult on cytology alone. While FNAC is a better diagnostic tool for finding AFBs hence confirming the diagnosis, biopsy is better for immunochemistry. Thus, biopsy and FNA complement each other.
皮肤结核的诊断具有挑战性，因其临床表现多样、菌量少且缺乏合适的诊断检测方法。临床病理相关性仍常用于诊断。关于细胞形态学特征的文献较少。免疫化学可作为辅助检测手段。
通过全面的病史和体格检查进行临床诊断。采用改良细针穿刺技术收集细胞学样本，并进行3毫米钻孔活检以进行组织学检查。将组织病理学结果与细胞形态学进行比较。使用基于聚合物的标准辣根过氧化物酶免疫化学技术，用抗结核多克隆抗体进行免疫化学染色，并比较细胞学和组织学结果。
活检和细胞学的形态学谱在九个参数上显示出高度相关性：坏死、肉芽肿、巨细胞、抗酸杆菌、中性粒细胞浸润、淋巴细胞存在、组织细胞、胶原束和免疫化学。发现细针穿刺抽吸术（FNA）与活检的诊断相关性为90.3%。比较瘰疬性皮肤结核和寻常狼疮的细胞形态学，除肉芽肿、巨细胞和免疫化学外，所有参数在瘰疬性皮肤结核中出现的频率更高。免疫化学在活检时的敏感性和特异性分别为90.3%和70%，而在FNA时分别为67.7%和60%。免疫组织化学（IHC）和免疫细胞化学（ICC）的联合敏感性为96.8%。
皮肤结核的细胞形态学谱与临床组织病理学相当，相关性高达90.3%。然而，仅靠细胞学对FNA进行亚分类是困难的。虽然细针穿刺抽吸活检（FNAC）是发现抗酸杆菌从而确诊的更好诊断工具，但活检更适合进行免疫化学检测。因此，活检和FNA相互补充。
