Background: More than 200,000 new cases of leprosy are detected, annually, around the world. Brazil is the second country in highest incidence, behind only India. Even in endemic places like Brazil, the diagnosis of leprosy can be very challenging, since in some regions there is an average delay of two years for it. With the progressive increase in migratory flows, non-endemic countries may also meet this challenge. Besides, not uncommonly, physicians have difficulty distinguishing tuberculoid form of leprosy (TL) from sarcoidosis' cutaneous manifestation. The latter is multisystemic and also manifests as a chronic granulomatous inflammation. Classically, the histopathology of TL is characterized by granulomas surrounded by evident lymphocytic rim, whereas that of sarcoidosis by naked granulomas, i.e., surrounded by rare lymphocytes. However, such findings are not always present in daily practice, which makes these two diseases often clinically and histopathologically similar. The present work aimed, therefore, investigate criteria that aid in their distinction, either through standard optical microscopy or through newer tools such as second harmonic generation - SHG (non-linear optical microscopy). Material and Methods: Skin biopsies from 33 patients with TL and 24 with sarcoidosis were reviewed in hematoxylin and eosin (H&E) and silver (Gomori technique) staining. Two distinct observers blindly evaluated twenty-four histomorphological findings on H&E staining, in order to verify if any of them had significant predictive diagnosis value to TL or sarcoidosis. The specimens stained by silver were photographed and evaluated through the morphometry of the virtual cycloids in order to estimate the predictive diagnosis value of the mean density of the reticulin fibers. From the H&E stained specimens, the SHG images were obtained and collagen features of density and texture were analyzed. Results: Nine of the 24 histomorphological characteristics analyzed presented significant predictive value for the diagnosis of HT or sarcoidosis. The mean density of reticulin fibers was significantly higher in sarcoidosis than in HT. However, using logistic regression, this variable did not discriminate the two diseases. Among the four characteristics evaluated in SHG images (optical density, entropy, contrast and second angular momentum), only contrast was useful, revealing significant predictive diagnosis value, being higher in sarcoidosis. Conclusions: Histomorphologic, histomorphometric, or SHG imaging may be insufficient to differentiate HT from sarcoidosis, if evaluated alone. However, when combined, they can become very useful tools in this endeavor. Our results reinforce the importance of morphometry for a more objective histological analysis of the diseases, and open the doors for the study of cutaneous collagen in the granulomatous disorders.
BT - School of Medical Sciences of State University of Campinas LA - por, eng N2 -Background: More than 200,000 new cases of leprosy are detected, annually, around the world. Brazil is the second country in highest incidence, behind only India. Even in endemic places like Brazil, the diagnosis of leprosy can be very challenging, since in some regions there is an average delay of two years for it. With the progressive increase in migratory flows, non-endemic countries may also meet this challenge. Besides, not uncommonly, physicians have difficulty distinguishing tuberculoid form of leprosy (TL) from sarcoidosis' cutaneous manifestation. The latter is multisystemic and also manifests as a chronic granulomatous inflammation. Classically, the histopathology of TL is characterized by granulomas surrounded by evident lymphocytic rim, whereas that of sarcoidosis by naked granulomas, i.e., surrounded by rare lymphocytes. However, such findings are not always present in daily practice, which makes these two diseases often clinically and histopathologically similar. The present work aimed, therefore, investigate criteria that aid in their distinction, either through standard optical microscopy or through newer tools such as second harmonic generation - SHG (non-linear optical microscopy). Material and Methods: Skin biopsies from 33 patients with TL and 24 with sarcoidosis were reviewed in hematoxylin and eosin (H&E) and silver (Gomori technique) staining. Two distinct observers blindly evaluated twenty-four histomorphological findings on H&E staining, in order to verify if any of them had significant predictive diagnosis value to TL or sarcoidosis. The specimens stained by silver were photographed and evaluated through the morphometry of the virtual cycloids in order to estimate the predictive diagnosis value of the mean density of the reticulin fibers. From the H&E stained specimens, the SHG images were obtained and collagen features of density and texture were analyzed. Results: Nine of the 24 histomorphological characteristics analyzed presented significant predictive value for the diagnosis of HT or sarcoidosis. The mean density of reticulin fibers was significantly higher in sarcoidosis than in HT. However, using logistic regression, this variable did not discriminate the two diseases. Among the four characteristics evaluated in SHG images (optical density, entropy, contrast and second angular momentum), only contrast was useful, revealing significant predictive diagnosis value, being higher in sarcoidosis. Conclusions: Histomorphologic, histomorphometric, or SHG imaging may be insufficient to differentiate HT from sarcoidosis, if evaluated alone. However, when combined, they can become very useful tools in this endeavor. Our results reinforce the importance of morphometry for a more objective histological analysis of the diseases, and open the doors for the study of cutaneous collagen in the granulomatous disorders.
PY - 2018 EP - 98 T2 - School of Medical Sciences of State University of Campinas TI - [Histomorphologic, histomorphometric and nonlinear optical microscopy approach to differentiate skin lesions of patients with tuberculoid leprosy and sarcoidosis]. TT - Abordagens histomorfológica, histomorfométrica e de microscopia óptica não linear para diferenciação de lesões cutâneas de pacientes com hanseníase tuberculoide e sarcoidose UR - file:///C:/Users/Ikram/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/Utino_FabianeLeonel_D%20(1).pdf VL - PhD ER -