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Histoplasmosis of the Head and Neck Region Mimicking Malignancy: A Clinic-Pathological Predicament
Neha Mittal1, Asawari Patil, Priyamvada Singhal
1Department of Pathology, Tata Memorial Center, MUMBAI, INDIA.
Objective:
Histoplasmosis is a systemic, deep mycotic infection caused by Histoplasma capsulatum. Disseminated histoplasmosis (DH) is synonymous with HIV seropositive immunocompromised individuals; however, isolated histoplasmosis involving the head and neck mucosal sites mimicking malignancy is a clinical predicament. The result, in a superficial biopsy with marked pseudoepitheliomatous hyperplasia (PEH), in a tertiary care cancer center where the number of squamous carcinomas far outnumber the infectious diseases, could be catastrophic.
Material And Method:
The archives of a tertiary care cancer hospital were searched (2010-2019) for cases of histoplasmosis involving the head and neck mucosal sites in HIV non-reactive patients.
Results:
Six cases of isolated head and neck histoplasmosis were seen in biopsies from 4 men and 2 women, with an age range of 46-72 years. Three of these patients suffered from chronic illnesses. The most common site involved was the larynx (vocal cords) in three cases, two cases were involving lips, and one involving the tongue. The biopsies were reviewed in-house with a clinical diagnoses of malignancy in all and an outside biopsy diagnosis of "squamous cell carcinoma" in 2 cases. The important histological findings in the biopsy were PEH (3 cases), granulomas (2 cases), lymphoplasmacytic inflammation (all cases). Eosinophils were conspicuous by their absence. Intracellular histoplasma was seen in all cases, albeit to varying density, which was confirmed with GMS stain.
Conclusion:
A high index of suspicion, meticulous history taking by oncologists, and appropriate distinction of PEH from neoplastic squamous proliferation by pathologists in superficial biopsies and an apropos deeper wedge biopsy are essential to clinch the correct diagnosis.
Insights
Isolated head and neck histoplasmosis can mimic cancer in HIV-negative patients. Accurate diagnosis requires distinguishing pseudoepitheliomatous hyperplasia (PEH) from malignancy, especially in superficial biopsies.
Area of Science:
- Mycology
- Pathology
- Oncology
Background:
- Histoplasmosis is a deep fungal infection caused by Histoplasma capsulatum.
- Disseminated histoplasmosis (DH) typically affects immunocompromised individuals, particularly those with HIV.
- Isolated head and neck histoplasmosis can mimic malignancy, posing a diagnostic challenge, especially in HIV-negative patients.
Purpose of the Study:
- To identify and characterize cases of isolated head and neck histoplasmosis in HIV-non-reactive patients.
- To highlight the diagnostic challenges and potential misdiagnosis of this condition as squamous cell carcinoma.
Main Methods:
- A retrospective search of a tertiary care cancer hospital's archives from 2010-2019.
- Inclusion criteria: cases of histoplasmosis involving head and neck mucosal sites in HIV non-reactive patients.
- Review of biopsies, including histological findings and comparison with initial diagnoses.
Main Results:
- Six cases of isolated head and neck histoplasmosis were identified in HIV-negative patients (4 males, 2 females; age 46-72).
- The larynx was the most common site (3 cases), followed by lips (2 cases) and tongue (1 case).
- Histological findings included pseudoepitheliomatous hyperplasia (PEH), granulomas, and lymphoplasmacytic inflammation, with intracellular Histoplasma confirmed by GMS stain.
Conclusions:
- A high index of suspicion is crucial for diagnosing head and neck histoplasmosis in HIV-negative individuals.
- Pathologists must differentiate PEH from neoplastic squamous proliferation in superficial biopsies.
- Deeper wedge biopsies may be necessary for definitive diagnosis.
