Korean Lepr Bull.
2023 Dec;56(2):1.
Proposal of a scale in order to diagnose leprosy histopathologically in non-endemic area
- Affiliations
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- 1Department of dermatology, School of Medicine,Ewha Womans University, Seoul, Korea
Abstract
- Background
Importance of the histopathological findings for diagnosis of leprosy cannot be overstated. Understanding the histopathological characteristics of leprosy is eventual and the most hopeful way to diagnose leprosy in non-endemic area like Korea for we do not include leprosy as the differential diagnosis.
Objective
Dermatologists in non-endemic area reach to diagnose leprosy histopathologically through discriminating the degree of significance from many important and characteristic findings of leprosy
Methods
We have collected histopathological findings calling for diagnosis of leprosy from review articles, textbooks, booklets to classify them according to significance. Degree of significance was divided into four scales using three factors of nerve changes, granulomas, and infiltrates. Scales are as follows: suspicious, moderately concerned findings were called S1, highly concerned S2, strong, seriously concerned S3, and highly significant, conclusive S4
Results
1) Nerve(n.) changes were as follow: S1 was fragmented nervearound the center of epithelioid granuloma, no normal n. bundles outside the lesions. S2 was selective involvement of dermal n., perineurial changes. S3 was undergoing destruction and swelling of deep dermal n. by granuloma and no detectable n. S4 was AFBs, onion skin appearance of perineurial fibroblast proliferation, n. destruction by granulomas with anesthetic skin lesion 2) Characteristic granulomas for diagnosis of leprosy were as follow: S1 was epithelioid granulomas on the sweat glands and arrector pili muscle. S2 was epithelioid granulomas situated on the deep dermal n. bundles, epidermal erosion by granuloma associated with tubercles in entire dermis, linear or angulated tubercles. S3 was elongated tubercles along the n. in the deep dermis and also granulomas on the sweat glands and arrector pili muscles. S4 was AFBs. 3) Dermal infiltrates had following characteristics: S1 was lymphohistiocytic infiltrate that is more prominent around the adnexa than the vessels. S2 was selective lymphocytic infiltration and cuffing of deep dermal n. S3 was foamy macrophages of gray and granular cytoplasm. S4 was foamy macrophages with AFBs.
Conclusion
We propose a scale for discriminating the degree of significance to diagnose leprosy histopathologically when dermatologist in non-endemic area meet the leprosy-related findings.
