Molluscum-like cutaneous cryptococcosis: a histopathological and pathogenetic appraisal.
BACKGROUND
Molluscum-like cutaneous cryptococcosis (MLCC) is characterized by hypopigmented or skin-colored papules with central umbilication. The histomorphological nuances of Cryptococcus neoformans infection that effect mimicry of molluscum contagiosum are undocumented. This histopathological study was undertaken to assess the histopathological characteristics of MLCC and to determine potential evolutionary pathogenetic mechanisms and significance.


METHODS
A 5-year retrospective re-appraisal of cutaneous cryptococcosis biopsies with a clinical molluscum-like appearance.


RESULTS
All 26 specimens with a molluscum-like appearance showed a dome-shaped architecture with central invagination and dermal C. neoformans of varying size and shape, with capsular fragmentation; 20 biopsies had a paucireactive appearance and 6 combined granulomatous and paucireactive foci. Twenty, two and four biopsies showed transepidermal, transfollicular and combined transepidermal and transfollicular elimination (TFE) of fungi, necrobiotic collagen and debris through the central invagination, respectively. Subepithelial neutrophils and collagen necrobiosis were identified in 8 and 14 cases each, respectively. Varying sized and shaped yeasts, capsules of varying width, capsular fragmentation and collagen necrobiosis were ultrastructurally confirmed.


CONCLUSIONS
Transepithelial and TFE of C. neoformans, necrobiotic collagen, inflammatory cells and cellular debris account for the morphological attributes of MLCC. The eliminatory process is a potential public health hazard, serving as a vehicle for C. neoformans transfer to the exterior.
Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal & National Health Laboratory Services, Durban, KwaZulu Natal, South Africa.
Pratistadevi K
PK
Ramdial
Eduardo
E
Calonje
Yetish
Y
Sing
Nivesh A
NA
Chotey
Jamila
J
Aboobaker
D000328:Adult; D000368:Aged; D001706:Biopsy; D003453:Cryptococcosis / Q000382:microbiology / Q000473:pathology*; D003455:Cryptococcus neoformans / Q000302:isolation & purification* / Q000502:physiology / Q000648:ultrastructure; D003881:Dermatomycoses / Q000382:microbiology / Q000473:pathology*; D003937:Diagnosis, Differential; D004817:Epidermis / Q000382:microbiology / Q000473:pathology; D005260:Female; D018859:Hair Follicle / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008976:Molluscum Contagiosum / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult