Velpula Nagesh Kumar1 
, Shaik Raja Husne Kalam1 , Polisetty Satya Narayana Rao2 , Gollapalli Sobha Rani * 3
, Shaik Raja Husne Kalam1 , Polisetty Satya Narayana Rao2 , Gollapalli Sobha Rani * 3
1- Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh
2- Department of Pathology, Government Medical College, Eluru-534001, Andhra Pradesh
3- Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh ,drsobharanipath@gmail.com
2- Department of Pathology, Government Medical College, Eluru-534001, Andhra Pradesh
3- Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh ,
Keywords: Histopathology, Biopsy, Leprosy, Carcinoma, Basal Cell, Adenocarcinoma, Sebaceous, Adenoma, Pleomorphic
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Introduction
The skin, being the largest organ in the body, is indeed complex. It involves precisely regulated cellular and molecular interactions that govern many essential processes. One of its primary roles is to serve as a defense mechanism against harmful environmental agents (1). Skin diseases encompass a wide range of inflammatory and neoplastic lesions. These dermatological conditions are prevalent worldwide. In India, for instance, the prevalence of skin diseases is reported to range from 6.3% to 11.16% (2, 3). While many skin lesions can be diagnosed clinically based on patient history and physical examination of the lesions, some cases require additional diagnostic tests. These can include a potassium hydroxide (KOH) preparation to identify fungal elements, a clinical examination under Wood’s light, and biopsies from skin lesions. These additional tests can provide crucial information that aids in reaching a final diagnosis.
Indeed, the clinical presentation of dermatological diseases can be quite narrow, with signs, such as hypopigmentation, hyperpigmentation, macules, papules, nodules, and a few others. However, the histomorphology of skin diseases reveals a much more diverse range of disease processes. Accurate diagnosis of skin disorders, especially those presenting with similar clinical lesions, is of utmost importance, as it aids clinicians in deciding the appropriate management plan (4). The aim of the current study was to evaluate the histomorphological spectrum and distribution of skin lesions at a tertiary care teaching institute.
Methods
This retrospective study collected data from the patients’ medical records over two years, from June 2021 to May 2023 at the Department of Pathology of the Government Medical College (GMC, Kadapa, Andhra Pradesh, India).
Inclusion and exclusion criteria:
In this study, all adequate skin biopsies received by the Department of Pathology of GMC in Kadapa were included. However, any samples that were inadequate, poorly fixed, or auto-analyzed were excluded from the study.
Data collection
The Department of Pathology at GMC received a total of 4363 biopsy specimens, of which 202 were skin biopsies. These samples underwent a routine processing procedure. They were fixed in 10% neutral buffered formalin, embedded, and sectioned at a thickness of 4-5 microns. The sections were then stained with Hematoxylin & Eosin for examination. In certain cases, special stains, such as Ziehl-Neelsen (ZN) stain, Periodic Acid Schiff’s (PAS) stain, and Wade-Fite or Fite-Faraco (FF) staining, were used as required. This comprehensive approach ensures a thorough examination of the samples. Along with the specimens, requisitions were sent to obtain demographic data, providing valuable context for the analysis of the biopsy results.
Statistical analysis
The data collected in this study was recorded using a Microsoft Excel sheet. Statistical analyses were performed using SPSS Version 21.0 (USA). Frequency percentages were utilized to measure the prevalence of various skin disorders based on histopathological findings. A P-value of less than 0.05 was considered statistically significant.
Results
In this study, a total of 202 skin biopsies were examined. The age of the patients ranged from eight to 87 years. The distribution of cases across different age groups was as follows: 31-40 years: 42 cases (20.8%); 41-50 years: 41 cases (20.2%); 51-60 years: 39 cases; 21-30 years: 31 cases; and 61-70 years: 20 cases.
In this study, males constituted 112 cases (55.5%) and females constituted 90 cases (44.5%), resulting in a male-to-female ratio of 1.2:1. The most common site of skin disease was the trunk, with 80 cases (40%), followed by the upper limb with 51 cases (25%). The histopathological examination of these lesions led to their categorization into eight groups. The categorization of skin diseases, based on their site, pattern of involvement, and cytological features as suggested in the Lever’s Histopathology of the Skin (5) (Table 1) is as follows:
The skin, being the largest organ in the body, is indeed complex. It involves precisely regulated cellular and molecular interactions that govern many essential processes. One of its primary roles is to serve as a defense mechanism against harmful environmental agents (1). Skin diseases encompass a wide range of inflammatory and neoplastic lesions. These dermatological conditions are prevalent worldwide. In India, for instance, the prevalence of skin diseases is reported to range from 6.3% to 11.16% (2, 3). While many skin lesions can be diagnosed clinically based on patient history and physical examination of the lesions, some cases require additional diagnostic tests. These can include a potassium hydroxide (KOH) preparation to identify fungal elements, a clinical examination under Wood’s light, and biopsies from skin lesions. These additional tests can provide crucial information that aids in reaching a final diagnosis.
Indeed, the clinical presentation of dermatological diseases can be quite narrow, with signs, such as hypopigmentation, hyperpigmentation, macules, papules, nodules, and a few others. However, the histomorphology of skin diseases reveals a much more diverse range of disease processes. Accurate diagnosis of skin disorders, especially those presenting with similar clinical lesions, is of utmost importance, as it aids clinicians in deciding the appropriate management plan (4). The aim of the current study was to evaluate the histomorphological spectrum and distribution of skin lesions at a tertiary care teaching institute.
Methods
This retrospective study collected data from the patients’ medical records over two years, from June 2021 to May 2023 at the Department of Pathology of the Government Medical College (GMC, Kadapa, Andhra Pradesh, India).
Inclusion and exclusion criteria:
In this study, all adequate skin biopsies received by the Department of Pathology of GMC in Kadapa were included. However, any samples that were inadequate, poorly fixed, or auto-analyzed were excluded from the study.
Data collection
The Department of Pathology at GMC received a total of 4363 biopsy specimens, of which 202 were skin biopsies. These samples underwent a routine processing procedure. They were fixed in 10% neutral buffered formalin, embedded, and sectioned at a thickness of 4-5 microns. The sections were then stained with Hematoxylin & Eosin for examination. In certain cases, special stains, such as Ziehl-Neelsen (ZN) stain, Periodic Acid Schiff’s (PAS) stain, and Wade-Fite or Fite-Faraco (FF) staining, were used as required. This comprehensive approach ensures a thorough examination of the samples. Along with the specimens, requisitions were sent to obtain demographic data, providing valuable context for the analysis of the biopsy results.
Statistical analysis
The data collected in this study was recorded using a Microsoft Excel sheet. Statistical analyses were performed using SPSS Version 21.0 (USA). Frequency percentages were utilized to measure the prevalence of various skin disorders based on histopathological findings. A P-value of less than 0.05 was considered statistically significant.
Results
In this study, a total of 202 skin biopsies were examined. The age of the patients ranged from eight to 87 years. The distribution of cases across different age groups was as follows: 31-40 years: 42 cases (20.8%); 41-50 years: 41 cases (20.2%); 51-60 years: 39 cases; 21-30 years: 31 cases; and 61-70 years: 20 cases.
In this study, males constituted 112 cases (55.5%) and females constituted 90 cases (44.5%), resulting in a male-to-female ratio of 1.2:1. The most common site of skin disease was the trunk, with 80 cases (40%), followed by the upper limb with 51 cases (25%). The histopathological examination of these lesions led to their categorization into eight groups. The categorization of skin diseases, based on their site, pattern of involvement, and cytological features as suggested in the Lever’s Histopathology of the Skin (5) (Table 1) is as follows:
- Group 1: Diseases limited to the epidermis and stratum corneum (n=11, 5.45%).
- Group 2: Diseases with localized superficial epidermal or melanocytic proliferation (n=7, 3.46%).
- Group 3: Diseases of the superficial cutaneous reactive unit (n=47, 23.26%).
- Group 4: Diseases with acantholytic, vesicular, and pustular morphology (n=13, 6.45%).
- Group 5: Diseases with perivascular, diffuse, and granulomatous infiltrate of the reticular dermis (n=40, 19.8%).
- Group 6: Tumors and cysts of the dermis and subcutis (n=77, 38.11%).
- Group 7: Inflammatory disorders of skin appendages (n=3, 1.49%).
- Group 8: Disorders of the subcutis (n=4, 1.98%).
Out of 202 samples, the majority of lesions were non-neoplastic, accounting for 180 cases (89.1%). The most common type of these non-neoplastic lesions was the epidermal cyst, found in 16 cases (7.92%). Neoplastic lesions, both benign and malignant, were found in 22 cases, making up 10.9% of the total. When specifically examining the malignant neoplastic lesions (12 cases in total), basal cell carcinoma was the most common, found in six cases (50%) of the malignant neoplastic lesions, followed by squamous cell carcinoma, which was found in four (33.4%) cases of the malignant neoplastic lesions (Figure 1 & Figure 2).
.PNG)
Out of the total cases, 38.1% (n=77) were classified under group 6. The distribution of cases among the other groups is as follows: Group 1 included 11 cases (5.45%), all of which were diagnosed with vitiligo. Group 2 comprised seven cases (3.46%), group 3 included 47 cases (23.26%), group 4 included 13 cases (6.45%), and group 5 contained 40 cases (19.8%). As mentioned earlier, group 6 had the highest number of cases with 77 (38.11%). Lastly, group 7 and group 8 included three cases (1.49%) and four cases (1.98%), respectively (Figure 3).
.PNG)
.PNG)
Discussion
Dermatological lesions represent a diverse group of disorders, each with unique clinical and histomorphological characteristics. The definitive method for diagnosing these disorders is through histopathological examination. In our recent study, we analyzed 202 skin biopsies. The most frequently represented age group was 31-40 years, accounting for 20.8% of the cases. This finding aligns with the results of studies co nducted by Bharadwaj V et al. (6) and Gupta et al. (7). In our study, male predominance was observed, with a male-to-female ratio of 1.2:1, which is similar to studies by Chandrakanta et al. (8), Yalla ASD et al. (9), Singh S et al. (10), Agarwal D et al. (11), and Mehar R et al. (12).
In our examination of 202 skin lesions, we identified neoplastic lesions in 22 cases, representing 10.9% of the total. The skin lesions were classified into eight groups, based on factors, such as the site of the lesion, the pattern of involvement, and cytological features. The majority of the cases fell into group 6, accounting for 77 cases (38.1%). Within this group, the most common lesion was the epidermal cyst, with 16 cases (7.92%). These findings are consistent with the results of studies conducted by Bharadwaj V et al., Gaikwad SL et al. (14), Yadav S et al. (15), and Sushma C et al. (16). Among the neoplastic lesions, basal cell carcinoma was observed in six cases (2.97%), which is similar to the findings of studies by Mamatha K et al. (1.74%), Bharadwaj V et al. (1.52%), Goswami P et al. (2.13%), and Amruth et al. (1.19%) (17).
In our research, the second most frequently involved group was group 3, which included diseases of the superficial cutaneous reactive unit. Within this group, psoriasis was the most common lesion, observed in 11 cases (5.4%). This finding differs from the results of studies by Mamatha K et al., where Lichen planus was the most common lesion. Group 5, which encompassed diseases with perivascular diffuse and granulomatous infiltrate of the reticular dermis, was the third most common group in our study, accounting for 40 cases (19.8%). Among these lesions, leprosy was the most common, observed in 19 cases (9.4%), whereas studies by Mamatha K et al. and Adhikari RC et al. (18) reported higher incidence rates. In our research, group 4, which included diseases with an acantholytic vesicular and pustular morphology, was represented by bullous pemphigoid as the most common lesion in six cases (2.97%). This contradicts the findings of a study by Mamatha K et al., where pemphigus vulgaris was reported as the most common condition in this group.
In our study, group 1 diseases, which are limited to the epidermis and stratum corneum, included seborrheic keratosis in four cases, accounting for 1.98% of the total. Group 7 skin lesions, which are inflammatory disorders of skin appendages, included discoid lupus erythematosus as the only lesion in this group, observed in three cases (1.48%). Group 8 disorders, which affect the subcutis, included calcinosis cutis as the most common lesion, observed in three cases (1.48%).
Conclusion
Dermatopathological lesions encompass a diverse group of disorders, each with a broad clinical and histopathological spectrum. The gold standard for confirming a diagnosis is a histopathological examination of skin biopsies, which can be further supported by ancillary techniques. Among these conditions, leprosy is the most common, underscoring the importance of effective preventive measures for control.
Acknowledgement
None.
Funding sources
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical statement
This study was performed in accordance with the Declaration of Helsinki, and written informed consent was obtained from the participants. The study protocol was approved by the Institutional Ethics Committee of the GMC, Kadapa, Andhra Pradesh, India.
Conflicts of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Author contributions
S.K., P.S.N., and G.S.R. analyzed and interpreted the patient’s data regarding. V.N. and S.K. performed the histological examinations and were major contributors to writing the manuscript. P.S.N. and G.S. supervised the project and were responsible for editing the manuscript. All authors read and approved the final manuscript.
|
Table 1. Categorization of skin lesions according to the groups
.PNG) |
Discussion
Dermatological lesions represent a diverse group of disorders, each with unique clinical and histomorphological characteristics. The definitive method for diagnosing these disorders is through histopathological examination. In our recent study, we analyzed 202 skin biopsies. The most frequently represented age group was 31-40 years, accounting for 20.8% of the cases. This finding aligns with the results of studies co nducted by Bharadwaj V et al. (6) and Gupta et al. (7). In our study, male predominance was observed, with a male-to-female ratio of 1.2:1, which is similar to studies by Chandrakanta et al. (8), Yalla ASD et al. (9), Singh S et al. (10), Agarwal D et al. (11), and Mehar R et al. (12).
In our examination of 202 skin lesions, we identified neoplastic lesions in 22 cases, representing 10.9% of the total. The skin lesions were classified into eight groups, based on factors, such as the site of the lesion, the pattern of involvement, and cytological features. The majority of the cases fell into group 6, accounting for 77 cases (38.1%). Within this group, the most common lesion was the epidermal cyst, with 16 cases (7.92%). These findings are consistent with the results of studies conducted by Bharadwaj V et al., Gaikwad SL et al. (14), Yadav S et al. (15), and Sushma C et al. (16). Among the neoplastic lesions, basal cell carcinoma was observed in six cases (2.97%), which is similar to the findings of studies by Mamatha K et al. (1.74%), Bharadwaj V et al. (1.52%), Goswami P et al. (2.13%), and Amruth et al. (1.19%) (17).
In our research, the second most frequently involved group was group 3, which included diseases of the superficial cutaneous reactive unit. Within this group, psoriasis was the most common lesion, observed in 11 cases (5.4%). This finding differs from the results of studies by Mamatha K et al., where Lichen planus was the most common lesion. Group 5, which encompassed diseases with perivascular diffuse and granulomatous infiltrate of the reticular dermis, was the third most common group in our study, accounting for 40 cases (19.8%). Among these lesions, leprosy was the most common, observed in 19 cases (9.4%), whereas studies by Mamatha K et al. and Adhikari RC et al. (18) reported higher incidence rates. In our research, group 4, which included diseases with an acantholytic vesicular and pustular morphology, was represented by bullous pemphigoid as the most common lesion in six cases (2.97%). This contradicts the findings of a study by Mamatha K et al., where pemphigus vulgaris was reported as the most common condition in this group.
In our study, group 1 diseases, which are limited to the epidermis and stratum corneum, included seborrheic keratosis in four cases, accounting for 1.98% of the total. Group 7 skin lesions, which are inflammatory disorders of skin appendages, included discoid lupus erythematosus as the only lesion in this group, observed in three cases (1.48%). Group 8 disorders, which affect the subcutis, included calcinosis cutis as the most common lesion, observed in three cases (1.48%).
Conclusion
Dermatopathological lesions encompass a diverse group of disorders, each with a broad clinical and histopathological spectrum. The gold standard for confirming a diagnosis is a histopathological examination of skin biopsies, which can be further supported by ancillary techniques. Among these conditions, leprosy is the most common, underscoring the importance of effective preventive measures for control.
Acknowledgement
None.
Funding sources
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical statement
This study was performed in accordance with the Declaration of Helsinki, and written informed consent was obtained from the participants. The study protocol was approved by the Institutional Ethics Committee of the GMC, Kadapa, Andhra Pradesh, India.
Conflicts of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Author contributions
S.K., P.S.N., and G.S.R. analyzed and interpreted the patient’s data regarding. V.N. and S.K. performed the histological examinations and were major contributors to writing the manuscript. P.S.N. and G.S. supervised the project and were responsible for editing the manuscript. All authors read and approved the final manuscript.
Article Type: Research |
Subject:
Basic medical sciences
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