title: Clinical, histopathologic, and cytologic diagnosis of mucosal leishmaniasis and literature review.
abstract: BACKGROUND
  Mucosal leishmaniasis (ML) is a rare disease in the world, even in endemic areas such as Iran. Clinical, histologic, or cytologic assessment may help in the diagnosis of ML.
  
  
  OBJECTIVE
  To describe clinical, histologic, and cytologic findings in ML.
  
  
  METHODS
  Review of our files showed 11 patients diagnosed with ML, of whom 7 patients had oral lesions, 1 of whom was a known patient with oral leishmaniasis with recurrence of oral lesions; 2 had laryngeal lesions; and 3 had nasal lesions. One case of laryngeal leishmaniasis was a recurrence of prior oral lesions. Cytologic smears were prepared by scraping the lesions with a scalpel or cytobrush. Histology on the biopsies was done for 7 patients. In 2 patients with nasal lesions, exfoliative cytology was made by washing the nasal cavity. Smears were both air dried and fixed in alcohol and stained.
  
  
  RESULTS
  Cytologic findings showed free Leishman-Donovan bodies, intrahistiocytic Leishman-Donovan bodies, atypical organisms, granuloma, acute and chronic inflammatory cells, histiocytes, multinucleated giant cells, mast cells, binucleated histiocytes (Reed-Sternberg-like cells), and plasma cells. In 6 of the patients, biopsy was inconclusive and in subsequent cytology the organism was detected. In 3 cases, findings from clinical and cytologic examinations were suggestive for leishmaniasis; however, with response to treatment, the diagnosis was confirmed. In 5 patients a malignant tumor was suspected because of clinical or histologic findings, but cytology helped to diagnose leishmaniasis.
  
  
  CONCLUSIONS
  Clinically or histologically, ML can be mistaken for benign and malignant lesions. Scraping or exfoliative cytology is an easy, reliable, and cost-effective method for diagnosing ML. Thus, clinical, histologic, and cytologic features together may help in ML diagnosis.
authors.affiliation: Department of Cytopathology, Dr Daneshbod Pathology Laboratory, Shiraz, Iran. y@daneshbod.com
authors.forename: Yahya
authors.initials: Y
authors.lastname: Daneshbod
authors.forename: Ahmad
authors.initials: A
authors.lastname: Oryan
authors.forename: Mehdi
authors.initials: M
authors.lastname: Davarmanesh
authors.forename: Sadegh
authors.initials: S
authors.lastname: Shirian
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Negahban
authors.forename: Azita
authors.initials: A
authors.lastname: Aledavood
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Davarpanah
authors.forename: Hossein
authors.initials: H
authors.lastname: Soleimanpoor
authors.forename: Khosrow
authors.initials: K
authors.lastname: Daneshbod
mesh_terms: D000328:Adult; D001706:Biopsy; D003581:Cytodiagnosis / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006644:Histiocytes / Q000469:parasitology / Q000473:pathology; D006801:Humans; D007891:Leishmania / Q000302:isolation & purification; D007897:Leishmaniasis, Mucocutaneous / Q000175:diagnosis* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000469:parasitology / Q000473:pathology; D009062:Mouth Neoplasms / Q000175:diagnosis; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult