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Head and neck histoplasmosis--a nightmare for clinicians and pathologists! Experience at a tertiary referral cancer

Seethalakshmi Viswanathan1, Naveen Chawla, Anil D'Cruz

  • 1Department of Pathology, Head and Neck Services, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, India. vishyvidya@hotmail.com

Head and Neck Pathology
|July 9, 2010
PubMed

Insights

Histoplasmosis, a rare deep fungal infection in India, can manifest in the head and neck, mimicking cancer. Early suspicion and biopsy are crucial for accurate diagnosis, especially in immunocompromised individuals.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Oncology

Background:

  • Histoplasmosis is an uncommon deep fungal infection in India.
  • Oral or oropharyngeal histoplasmosis can be an isolated finding or part of disseminated disease.
  • Immunosuppression, particularly from HIV and diabetes, increases risk.

Observation:

  • A review of five head and neck histoplasmosis cases at a cancer institute revealed clinical presentations resembling malignancy.
  • Three cases were initially misdiagnosed as cancer due to pseudoepitheliomatous hyperplasia on biopsy.
  • Definitive surgical treatment was performed based on initial misdiagnosis.

Findings:

  • Histoplasmosis can mimic head and neck cancer both clinically and pathologically.
  • Pseudoepitheliomatous hyperplasia can lead to erroneous biopsy diagnoses of malignancy.
  • Subsequent excisions revealed characteristic histoplasmosis features.

Implications:

  • Isolated oral histoplasmosis poses a diagnostic challenge, potentially leading to incorrect cancer treatment.
  • A high index of suspicion is vital for patients with overt or hidden immunosuppression.
  • Deep wedge biopsies are recommended to confirm histoplasmosis by identifying organisms in subepithelial tissue.
Keywords:
HistoplasmosisImmunosuppressionMalignancyMimicOralPseudoepitheliomatous hyperplasia

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