The Histopathological Profile Of Non-Neoplastic Dermatological Disorders With Special Reference To Granulomatous Lesions - Study At A Tertiary Care Centre In Pondicherry

摘要

BackgroundDermatologic disorders are common in many countries but the spectrum varies greatly. The objective of this study was to determine the histopathological profile of non-neoplastic dermatological lesions, to study the morphology and attempt to find the etiology of granulomatous lesions on skin biopsies . MethodsThis is a retrospective study over a period of two years in the department of pathology, IGMC &RI. Out of a total of 248 skin biopsies received, 112 cases with non-neoplastic skin lesions were included in the study. Incisional biopsy, excision biopsy and punch biopsy were done to obtain tissue for histopathological examination. Slides stained with routine stain and special stains like Ziehl - Neelsen stain, Periodic Acid Schiff, Alcian blue and Fite faraco were reviewed. Data entry and analysis were done using statistical software SPSS for Windows Version 16.0 (SPSS Inc., Chicago, IL, USA). Percentages were calculated for categorical variables. Chi-square test was used for comparison of proportions of different groups. Chi-square test for trend was used for studying the linear trend in occurrence of various skin lesions with age. All p values < 0.05 were considered significant, while p values between 0.05 and 0.10 were considered marginally significant . ResultsA total of 112 patients were included in the study, 61 cases (54.5%) males and 51 cases (45.5%) females. In males, the commonest lesions were nonspecific dermatoses (n=17, 27.9%) followed by granulomatous lesions (n-14, 23%) and in females the commonest lesions were granulomatous lesions (n= 12, 23.5%) followed by nonspecific dermatoses (n= 11, 21.6%)(Table 1). The sex distribution of various non-neoplastic lesions was of no statistical significance except for vasculitis which was commoner in females (p value-0.0175). Miscellaneous lesions included cases of Hidradenitis suppurativa , folliculitis and lichen sclerosus et atrophicus. The prevalence of calcinosis cutis was highest in the age-group 41-60 years (p = 0.0117) (Table 2). All cases of nonspecific ulcers (p = 0.0389) and vasculitis ( 0.0679) were also higher in the same age group. Calcinosis cutis and vasculitis showed a statistically significant increasing linear trend with age (p value 0.0025 and 0.0140, respectively) (Figure 1). Similarly, lichen planus showed a statistically significant decreasing linear trend with age (p value= 0.0378) (Figure 1). 26 out of 112 (23.2%) skin biopsies, were found to have a granulomatous reaction pattern. The commonest etiology of granuloma in our study was leprosy accounting for 12 cases followed by 11 cases of tuberculosis. Less common causes included erythema nodosum and granuloma annulare (Table 3). The typified 5 cases of tuberculosis were lupus vulgaris (3 cases) and tuberculosis verrucosa cutis (2 cases). Special stain for AFB were positive in 11.5% of all cases. ConclusionsSkin biopsies with non-neoplastic lesions constituted 45% of the total number of skin biopsies at our institute. The age distribution pattern indicated highest percentage in the 41-6o year age group (36.6%). The sex distribution pattern revealed a male preponderance of 54.5% compared to 45.5 % females. Granulomatous dermatoses are still rampant, infections forming an important cause of granulomatous dermatitis with leprosy and tuberculosis as the leading causes. Majority of the cases of leprosy were borderline tuberculoid (BT), followed by tuberculoid (TT) leprosy . Demonstration of acid fast bacilli by ZN stain is specific, however, they are not detected with ease thereby further emphasizing the significance of adequate clinical data and workup which helps in elucidation of specific etiology. Introduction The pattern of skin diseases varies from one country to another and across different parts within the same country. Studies from developing countries conducted over a period of years in the past have reported high prevalence of skin disorders, the spectrum of which has been highly vari