Splendore-Hoeppli phenomenon on fine needle aspiration cytology of subcutaneous inflammatory lesions

To put forth the importance of Splendore-Hoeppli (SH) material on fine needle aspiration cytology (FNAC) smears from subcutaneous inflammatory lesions.

This is a retrospective study that analyzes 33 cases of subcutaneous inflammatory lesions, diagnosed on FNAC over a 2.5-year period (January 2011-July 2013). Giemsa- and Papanicolaou (Pap)-stained smears were retrieved and reviewed.

The cytological counterpart of SH material can be seen as acellular, dense, nonfibrillary homogenous bodies of varying sizes and shapes, purple to blue on Giemsa-stained and greenish on Pap-stained smears, respectively. Of the 33 cases, 15 showed the presence of SH material on the smears; 11/15 cases with SH material were positive for fungus. Of the 18/33 cases that were negative for SH material, there were 7 acid-fast bacilli-positive tuberculous lesions, 8 nonspecific inflammatory lesions, and 3 fungal infections. None of the cases showed actinomycete filaments or clumps of bacterial colonies. Histopathology was available in 4 cases.

SH material should be recognized on cytology smears as it is an indicator of a specific etiology and also helps rule out nonspecific inflammatory and tuberculous lesions.