Histomorphometric approach to differentiate skin lesions of tuberculoid leprosy from sarcoidosis

ABSTRACT

Background

More than 200,000 new cases of leprosy are detected worldwide annually. Physicians commonly have difficulty in differentiating tuberculoid form of leprosy (TL) from sarcoidosis' cutaneous manifestation.

Methods

Skin biopsies of 33 patients with TL and 24 with sarcoidosis were reviewed on hematoxylin and eosin and Gomori stained sections, in order to find reliable criteria for distinguishing one disease from another.

Results

Nine of the 24 features analyzed presented significant predictive value for diagnosis (p < 0.05). Predominance of tuberculoid granulomas in adnexal and neural distribution, and granulomas replacing the nerves localized within sweat gland glomeruli were predictive to TL diagnosis. For sarcoidosis, dermal fibrosis, back-to-back distribution of the granulomas, presence of atypical giant cells and plasma cells, greater number of conventional giant cells, and spared nerves beside the granuloma were predictive criteria. The median surface density of reticulin fibers was significantly higher in sarcoidosis (3.44) than in TL (2.99). Nonetheless, using logistic regression, this variable did not discriminate the diseases (p = 0.096).

Conclusions

Isolated histological features are not fully predictive to differentiate the two diseases. However, those with statistical value can assist this distinction in diagnostic practice. Although the results of the analysis of the reticulin fibers density did not tell apart TL from sarcoidosis, they corroborate the idea of fibers fragmentation within tuberculoid leprosy granulomas, reiterating the importance of morphometry in the histological examination.