Head and neck histoplasmosis--a nightmare for clinicians and pathologists! Experience at a tertiary referral cancer centre.
Histoplasmosis is a rarely reported deep mycotic infection in the Indian context. Oral or oropharyngeal manifestation can occur as an isolated symptom or as part of a disseminated process associated with immunosuppression especially with HIV and diabetes. Five cases of head and neck histoplasmosis accrued over 6 years in a tertiary referral cancer institute were reviewed. All these patients presented clinically as cancer. In three patients, the marked pseudoepitheliomatous hyperplasia led to a mistaken biopsy diagnosis of malignancy following which definitive surgical treatment was performed. The subsequent excision revealed typical features of histoplasmosis. Isolated oral presentation of histoplasmosis can mimic malignancy both clinically as well as pathologically, leading to potentially disastrous consequences. A high index of suspicion in those with overt or hidden immunosuppression and a deep wedge biopsy to demonstrate the organisms in the subepithelial tissue is recommended.
Viswanathan
Seethalakshmi
S
Department of Pathology, Head and Neck Services, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, India. vishyvidya@hotmail.com
Chawla
Naveen
N
D'Cruz
Anil
A
Kane
Shubhada V
SV
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D048909:Diabetes Complications / Q000382:microbiology / Q000473:pathology; D003920:Diabetes Mellitus / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009062:Mouth Neoplasms / Q000175:diagnosis*
D000935:Antifungal Agents