Department of Pathology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
Centre of Biological Resource (CRB Amazonie), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
Front Cell Infect Microbiol. 2020 Oct 29;10:591974. doi: 10.3389/fcimb.2020.591974. eCollection 2020.
Disseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana.
Specimens from live patients from January 2005 to June 2020 with the presence of on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive.
Two hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%).
From the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of . With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.
在拉丁美洲，播散性组织胞浆菌病仍然是免疫功能低下患者的主要杀手。细胞和组织学方法通常存在于大多数医院，可能代表一种有价值的诊断方法。我们报告了法属圭亚那卡宴安德烈·罗塞蒙中心医院病理学系 15 年的经验。
分析了 2005 年 1 月至 2020 年 6 月期间有活患者存在的细胞学和/或组织学分析的标本。所有标本均由经验丰富的病理学家检查。分析是描述性的。
2005 年 1 月至 2020 年 6 月期间，202 例细胞学和组织学标本被诊断为组织胞浆菌病。202 例标本包括 153 例（75.7%）组织病理学福尔马林固定石蜡包埋组织（活检或手术标本）和 49 例（24.3%）来自所有器官的细胞学分析。134 例患者（82.7%）HIV 阳性，15 例（9.3%）接受免疫抑制剂治疗，13 例（8%）免疫功能正常。202 例中有 78 例（38.5%）为消化道标本，主要为结肠（53/78 例，70%）和小肠（14/78 例，18%）。消化道标本中的微生物数量多于其他器官（尤其是结肠）。所有阳性标本均观察到中度至明显强度的淋巴细胞和组织细胞炎症。16/78（20.5%）标本中存在 16/78（20.5%）结核样上皮样肉芽肿，包括 14 例结肠和 2 例小肠标本。202 例中有 11 例（5.4%）肝脏组织胞浆菌病，26 例（12.8%）肺部组织胞浆菌病。骨髓受累在 14 例（2%）标本中被诊断（8 例抽吸和 6 例活检）。42 例（31 例组织学和 11 例细胞学）淋巴结阳性。31 例淋巴结的组织病理学分析显示出不同的组织学表现。结核样形式最为常见（24/31，77.4%）。
从病理学家的角度来看，这是迄今为止最大的系列研究，表明消化道受累最常见，通常呈结核样形式，且负担更大。通过意识和专业知识，细胞学和病理学是广泛可用的方法，可以在短时间内提供挽救生命的结果，帮助指导临床医生面对可能致命的感染，需要及时治疗。
