title: Cutaneous leishmaniasis mimicking inflammatory and neoplastic processes: a clinical, histopathological and molecular study of 57 cases.
abstract: BACKGROUND
  Cutaneous leishmaniasis displays considerable variation in its histopathological and clinical presentation. Clinically, it progresses from a papule into a painless ulcerated and crusted nodule/papule. Microscopically, it progresses from sheets of amastigote-filled histiocytes to granulomatous inflammation.
  
  
  METHODS
  The study was conducted on 145 skin biopsies from untreated patients with histopathological and/or clinical suspicion of cutaneous leishmaniasis in Lebanon, Syria and Saudi Arabia (1992-2010). The pre-biopsy clinical diagnosis and demographic data were collected. Biopsies were evaluated for the major microscopic pattern, and the parasitic index (PI) was also determined. Diagnosis was confirmed by polymerase chain reaction (PCR) followed by molecular sub-speciation.
  
  
  RESULTS
  Of the 145 patients, 125 were confirmed as cutaneous leishmaniasis by PCR. Eighteen cases presented with a pre-biopsy clinical diagnosis other than cutaneous leishmaniasis that ranged from dermatitis to neoplasm. Of the 125 cases, 57 showed a major histopathological pattern other than cutaneous leishmaniasis. Identification of amastigotes was equivocal (PI ≤1) in 38 of the 57 cases. Of interest, all the 18 cases with a pre-biopsy clinical diagnosis other than cutaneous leishmaniasis also showed atypical histopathology for cutaneous leishmaniasis.
  
  
  CONCLUSIONS
  The manifestations of cutaneous leishmaniasis are broad and may mimic other inflammatory and neoplastic diseases. Pathologists and dermatologists should be aware of such pitfalls and can utilize PCR to confirm the diagnosis of leishmaniasis.
authors.affiliation: Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Jad
authors.initials: J
authors.lastname: Saab
authors.forename: Faysal
authors.initials: F
authors.lastname: Fedda
authors.forename: Ruba
authors.initials: R
authors.lastname: Khattab
authors.forename: Lamis
authors.initials: L
authors.lastname: Yahya
authors.forename: Asif
authors.initials: A
authors.lastname: Loya
authors.forename: Mohamed
authors.initials: M
authors.lastname: Satti
authors.forename: Abdul-Ghani
authors.initials: AG
authors.lastname: Kibbi
authors.forename: Mohammad Adib
authors.initials: MA
authors.lastname: Houreih
authors.forename: Wasim
authors.initials: W
authors.lastname: Raslan
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Sabban
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khalifeh
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003872:Dermatitis / Q000235:genetics / Q000469:parasitology / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000235:genetics / Q000469:parasitology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012878:Skin Neoplasms / Q000235:genetics / Q000469:parasitology / Q000473:pathology