Get Permission Padvi, Bhalara, and Dhruva: Study of histopathological spectrum of skin lesions at P.D.U Hospital, Rajkot


Introduction

The skin is the largest organ of the body, comprising of epidermis, dermis and hypodermis. Epidermis contains superficial lining epithelium. Dermis contains loose areolar tissue, blood vessels, sweat glands, sebaceous glands and root of hair follicles. Hypodermis contains mainly adipose tissue. Skin has important functions to perform like protection, temperature regulation and also metabolic.1 Among the out patients the patients with skin ailments form significant numbers and they constitute more numbers of hospital cases. They arise from the normal histological constituents of the skin. Different skin diseases comprise of non-specific, non infectious and infectious diseases to various types of benign and malignant tumorous (neoplastic) lesions. Vesiculobullous skin lesions are always the cause of concern to patients, clinicians and pathologists. Pemphigus vulgaris is an uncommon disease which is autoimmune in nature, but the most common among pemphigus group of skin diseases.2 Skin biopsy forms the fundamental basis for differentiation of similarly looking dermatological disorders and lesions, thereby giving valuable information to the pathologists to make a definitive diagnosis and more so to the dermatologist for better management of patients. Clinical diagnosis alone may not be conclusive many times and histopathology becomes a prime requisite for the definite diagnosis. Therefore, this study was designed to evaluate histopathology as an accurate diagnostic method for different types of non- neoplastic and neoplastic lesions of the skin and to correlate the clinical and histopathological findings of various skin lesions.3

Aims and Objectives

To confirm diagnosis and initiation of treatment. To study the histopathological spectrum of skin lesions at tertiary care hospital.To classify the most common disorders into their subtypes and thus asses the most common subtype prevalent in the surrounding community.4

Materials and Methods

A hospital-based study was conducted at P.D.U. Medical College, Rajkot, from August 2022 to July 2023. During this period, the department received a total of 374 skin biopsies. Relevant medical histories and other investigations were collected from each patient. Skin biopsies were received in histopathology department in 10% formalin with necessary clinical details obtained in histopathology requisition form. Specimens were processed in automated histokinette machine and pass through the steps of dehydration, clearing and impregnation, embedding in paraffin wax, blocks prepared of tissue, section cutting with microtome and tissue were taken on glass slide and stained with Hematoxyllin & Eosin stain. Special stains like ziehl-neelsen (Z-N stain), Periodic acid schiff (PAS) and fite-farraco stain also used whenever required.5, 4

Results

Out of 374 biopsies, 60% were from male patients while it was 40% from female patients, with a male: female ratio of 1.5:1 showing male predominance. The age of the patients ranged from 8 years to 76 years and the mean age was 38 years. On microscopic study, of cases were non neoplastic 98.4% lesions and 1.6% neoplastic lesions.3 Histopathological examination of the tissue was done so as to arrive at a definitive diagnosis. Most common histological spectrum was Dermatitis (28%), lepromatous leprosy 58.8%) was most commonly reported among the leprosy (27.3%). Then pemphigus vulgaris (49%) was the most commonly encountered vesicobullous lesions (25.7).6 In non-neoplastic lesion, commonest site was upper extremity, followed by back and lower extremity cases. In neoplastic lesion, commonest involved site was head and neck followed by lower extremity and trunk cases. In neoplastic disease, Squamous cell carcinoma (41.7%) is most common then basal cell carcinoma (33.3%).6, 7

Table 1

Spectrum of various skin lesions8

Skin disesases

No. of cases

Percentage (%)

Dermatitis

105

28.0

Leprosy

102

27.3

Vesicobullous lesions

96

25.7

Lupus lesions

16

4.3

Lichen planus

25

6.7

Neoplastic lesion

06

1.6

Indeterminate

24

6.4

Total

374

100

Table 2

Age and sex distribution of skin lesions9

Age group (years)

No. of cases (Male)

No. of cases (Female)

Total

Percentage (%)

0-20

25

12

37

9.9

21-40

89

59

148

39.6

41-60

83

52

135

36.0

>60

30

24

54

14.5

Total

227(60%)

147(40%)

374

100

Table 3

Spectrum of vesico-bullous lesions10, 11

Skin disesases

No. of cases

Percentage (%)

Pemphigus vulgaris

47

49

Pemphigus foliaceus

24

25

Darier’s disease

2

2

Hailey- Hailey Disease

3

3.1

Erythema multiforme

12

12.5

Millaria

08

8.4

Total

96

100

Table 4

Spectrum of leprosy12, 13, 14

Disease

No. of case

Percentage

Tuberculoid leprosy

10

9.8

Borderline tuberculoid leprosy

13

12.7

Borderline leprosy

04

3.9

Borderline lepromatous Leprosy

07

6.9

Lepromatous leprosy

60

58.8

Indeterminate leprosy

00

00

Histoid leprosy

03

3.0

Subpolar leprosy

05

4.9

Total

102

100

Table 5

Spectrum of neoplastic disease

Disease

No. of cases

Percentage (%)

Basal cell carcinoma

04

33.3

Squamous cell carcinoma

05

41.7

Nodular hidradenoma

03

25

Total

12

100

Discussion

In the present study 374 skin biopsies were analysed over a period of 1 year in the department of pathology of tertiary health center was evaluated. It was observed in the present study that skin lesions were more often seen in younger age groups with 50% cases seen below 40 years age. In the present study, the male preponderance was noted in skin lesions with 60% skin lesions being diagnosed in males. Inflammatory lesions were most commonly encountered followed by leprosy. Lepromatous leprosy (58.8%) is the most common in leprosy (27.3%) in this study.13 In neoplastic disease, Squamous cell carcinom (41.7%) is most common then basal cell carcinoma (33.3%). In Vesico-bullous lesions, pemphigus vulgaris (49%) is the most common.15

Conclusion

Majority of skin lesions were found in younger individuals with males (60%) being affected more commonly than females (40%).9 Leprosy (27.3%) is followed by dermatitis (28%) was the most commonly diagnosed entities. Lepromatous leprosy is the most common in leprosy in this study.16 Pemphigus vulgaris (49%) in vesico-bullous lesions, the most common in our study. In neoplastic disease, Squamous cell carcinoma is most common than basal cell carcinoma. Histopatholoical examination of skin biopsies remain gold standard in the diagnosis of skin lesions having their different clinical presentation and histomorphology. This signifies the role of histopathology in management and prognosis of skin lesion.5, 4, 13

Source of Funding

None.

Conflict of Interest

None.

References

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GV Achalkar Clinicopathological evaluation of non-neoplastic and neoplastic skin lesions: A study of 100 casesIndian J Pathol Oncol20196111822

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F Camacho-Alonso P Lopez-Jornet A Bermejo-Fenoll Pemphigus vulgaris presentation of 14 cases and review of the literatureMed Oral Patol Oral Cir Bucal20051042828

12 

N Singh A Bhatia VK Arora SN Bhattacharya A Malik Fine needle aspiration cytology of lepromatous leprosyIndian J Pathol Microbiol199841199

13 

DS Ridley Histological classification and the immunological spectrum of leprosyBull World Health Organ197451545165

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JA Savin RH Champion JL Burton FJ Eblnig Mycobacterial infectionsTextbook of Dermatology5th edBackwell Scientific PublicationOxford1992103363

15 

RM Potekar AP Javalgi LD Rodrigues RS Dwarampudi Histopathological Study of Infectious Granulomatous Skin LesionsAnn Pathol Lab Med2018575804

16 

M Farshcian A Kheirandish Clinico-pathological study of 12 cases of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000Int J Dermatol1991431290610



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Article History

Received : 14-04-2024

Accepted : 21-05-2024


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https://doi.org/10.18231/j.ijpo.2024.052


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