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Histopathological Findings of Primary Cutaneous Cryptococcosis

Abstract



Keywords



Cryptococcosis



Figure 1. (A) Histopathologic examination showed a granu- lomatous infiltration consists of histiocytes, lymphocytes and spores in the dermis. (H&E, ×100) (B) The PAS stain shows many round spores. (PAS, ×400) (C) The capsule stains blue with alcian blue (alcian blue, ×400).

Cryptococcosis is a systemic fungal disease caused by Cryptococcus species including Cryptococcus neoformans. C. neoformans is found in the stool of pigeons and in soil contaminated by them. It enters the body through the lungs and commonly spreads to the brain1. Primary cutaneous cryptococcosis is a very rare clinical entity, with no systemic but skin symptoms.

The histopathological staining of the spores is red with the periodic acid Schiff reaction. The capsule does not stain with hematoxylin and eosin or the PAS reaction, but due to its acid mucopolysaccharides, it stains blue with alcian blue, purple with methylene blue, and red with mucicarmine2. In the dermis, granulomatous infiltration could be detected consisting of histiocytes, lymphocytes, and spores (Fig. 1A). Several round spores stain with PAS (Fig. 1B). The capsule stains blue with alcian blue (Fig. 1C).

To diagnose primary cutaneous cryptococcosis, the lesion must be confined to the skin and no systemic invasion should occur for at least 4 weeks after the Cryptococcus species is confirmed3. Histopathological analysis, such as PAS and Alcian blue staining, is a successful method for identifying fungal spores and capsules.



References


1. 1. Sarossi GA, Silberfarb PM, Tosh FE. Cutaneous cryptococ- cosis: A sentinel of disseminated disease. Arch Dermatol 1971;104:1-3
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2. 2. Hinshaw MA, Longgley BJ. fungal diseases, In: Elder DE, Elenitsas R, Murphy GF, Rubin AI, Xu X, editors. Lever's histopathology of the skin. 11th ed. Philadelphia: Lippincott-Raven 2015:727-760


3. 3. Noble RC, Fajardo LF. Primary cutaneous cryptococcosis. Review and morphologic study. Am J Clin Pathol 1972; 57:13-22
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