S-100 immunostaining in the distinction of borderline tuberculoid leprosy from other cutaneous granulomas

Tirumalae, Rajalakshmi; Stany, Anto Ignat; Shanubhogue, Sharan; Yeliur, Inchara K.

doi:10.4103/0019-5154.135526

Cited by 4 publications

(7 citation statements)

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“…The present study demonstrates fragmented pattern of nerve involvement in most of the cases of BTL (56.7%) which is in concordance with several studies done by Gupta SK, et al, 10 Mohanraj A, et al, 11 and Thomas M, et al 12 Thirty percent of BTL showed both infiltrated and fragmented pattern which was predominant pattern observed in the study by Tirumalae R, et al 26 None of the BTL cases of the present study showed intact or absent pattern of nerve involvement whereas literature documents absent pattern in a proportion of cases. [10][11][12]26 The present study recognized absent and fragmented pattern of nerve involvement in 3.3% of BTL cases which is correlating with the cases reported by Mohanraj A, et al 11 In comparative analysis of the sensitivity of HE staining with S-100 immunostain in delineating the nerve involvement, we observed that the sensitivity of HE in delineating the nerve involvement is 68.3%. These result concords with the results of the study done by Tirumalae R, et al, who reported the sensitivity of 41%.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

Manjunath¹,

Manjunath²,

Basavaraj³

2021

IJPO

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S-100 immunohistochemical staining may detect nerve involvement in early stages of tuberculoid spectrum of leprosy. This study investigated the use of S-100 in early diagnosis of the tuberculoid and borderline tuberculoid leprosy and compared its sensitivity with hematoxylin and eosin (HE) stains in discerning the nerve involvement. To study the different histopathological patterns of nerve involvement in tuberculoid and borderline tuberculoid leprosy on S-100 immunostaining and also to compare the sensitivity of HE stain with S-100 immunostain in discerning the nerve involvement in these cases. This was a descriptive, prospective and retrospective analytical study, which included patients with tuberculoid spectrum of leprosy. Histopathological examination (HPE) and immunohistochemical (IHC) analysis were performed on all skin biopsies using HE stain and S-100 immunostain, respectively. Then the sensitivities of both the stains in discerning the nerve involvement were calculated and the data was analyzed using SPSS software version 22 by applying chi-square test. The study included a total of 58 patients [tuberculoid (n=28), borderline tuberculoid (n=30)]. The mean age was 43 yrs. The most common clinical manifestation was hypopigmented patches (n=40, 70%) with loss of sensation (n=39, 68.3%). HPE revealed 36 cases with well-defined granulomas, 22 cases with ill-defined granulomas and 41 cases with nerve destruction. IHC analysis showed four different patterns of nerve damage (fragmented, n=32; infiltrated and fragmented, n=14; infiltrated, n=10; intact, infiltrated and fragmented; n=1). The sensitivity and positive predictive value (PPV) of HE staining in delineating the nerve involvement were 68.96% and 100%, respectively. Whereas, the sensitivity and PPV of S-100 IHC were 100% each. Less number of cases. Use of S-100 IHC along with HPE aids in early, accurate and confirmatory diagnosis.

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Section: Discussionsupporting

confidence: 92%

Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

Manjunath¹,

Manjunath²,

Basavaraj³

2021

IJPO

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“…In our study, the most common clinical presentation was hypopigmented patches followed by loss of sensation and erythematous patches (Figure 2). Tiwari et al, 11 Khamankar et al, 12 Giridhar et al, 13 Tirumalae et al, 14 reported that hypopigmented patches were the most common presentation in TL leprosy (Figure 3). [11][12][13][14] It was seen that BI 3 or more had significant histopathological findings (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…Tiwari et al, 11 Khamankar et al, 12 Giridhar et al, 13 Tirumalae et al, 14 reported that hypopigmented patches were the most common presentation in TL leprosy (Figure 3). [11][12][13][14] It was seen that BI 3 or more had significant histopathological findings (Figure 4). In TL leprosy, bacilli could not be detected, diagnosis in such cases was made on the basis of histopathological findings that as the presence of epithelioid cell granuloma, giant cells, and periappendageal lymphocytes.…”

Section: Discussionmentioning

confidence: 99%

Role of S-100 stain for demonstration of different patterns of nerve changes in spectrum of leprosy – A prospective study

et al. 2022

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Background: A confirmatory diagnosis of tuberculoid (TL) and borderline TL (BTL) leprosy is dependent on the demonstration of nerve involvement within granuloma or acid-fast bacilli. It is very difficult to identify nerve elements in hematoxylin and eosin (H&E) stains. S-100 stain in this study is used to highlight nerve in TL leprosy so as to reach a definitive diagnosis of TL leprosy. Aim and Objectives: The aim of the study was to demonstrate nerve involvement and various changes of nerves in different forms of leprosy and use of S-100/or confirmation of TL leprosy/BTL leprosy. Materials and Methods: Skin biopsies of a total of 53 cases of leprosy were studied. The study is conducted in the department of pathology, HIMS, Safedabad, Barabanki U.P. The present study included all the new leprosy patients visiting the outpatient department of Skin and V.D, department, HIMS, Safedabad, Barabanki, U.P. Study period was 2015–2016 (1 year). All biopsies were studied in H&E stain. Biopsies were further subjected to S-100 stain so as to make a confirmatory diagnosis of TL leprosy/BTL and were then classified according to Ridley-Jopling classification only histological parameters of classification were used in this study. Results: In the present study, it was observed that the majority of patients were between the ages of 31 and 40 years (39.5%), males were mostly affected (10.5%), and family history was positive (8.4%). Hypopigmented skin lesion was the most common clinical lesion (31.2%).TT was the most common clinical diagnosis (25.4%). IL was the most common histopathological diagnosis (26.1%). The nerve changes were demonstrated in TL/BTL leprosy using S-100 immunostain. It was observed that the most of the cases of TL/BTL demonstrated fragments of nerves that were infiltrated by lymphocytes. This was the most common pattern seen among the patients of TL/BTL leprosy. Complete nerve was not identified in any of the cases. Conclusions: S-100 immunostain simplified detection of nerve twigs in TL/BTL leprosy. It was also seen that the most of the fragmented nerve elements were present within the granulomas. The TL spectrum of leprosy significantly affected nerves and using S-100 helped in differentiating it from other forms of leprosy.

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“…In such cases, the presence of inflammatory cells or granulomas in the endoneurium is an important indicator of leprosy. 12 Nerve remnants within granulomas are however confused with epithelioid cells, fragments of smooth muscle or endothelial cells. 5 S-100 is an immunohistochemical marker for Schwann cells, melanocytes, Langerhans cells, chondrocytes, and myoepithelial cells.…”

Section: Discussionmentioning

confidence: 99%

“…They also noticed some of the pitfalls while interpreting S-100 staining particularly Langerhans cells, which also stain positively with S-100 and are confused with nerve cells when present within granulomas. 12 In our case, we only considered S-100 stained cells as nerve cells when they were present in small clusters or along the contour of nerves.…”

Section: Discussionmentioning

confidence: 99%

Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy

Dhakhwa¹,

Acharya

Pradhan

et al. 2017

J Nepal Med Assoc

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Introduction:Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy.Methods: Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes. Results:Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases.Conclusions: S-100 immunostain is a useful auxiliary aid to the routine H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy.

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S-100 immunostaining in the distinction of borderline tuberculoid leprosy from other cutaneous granulomas

Cited by 4 publications

References 1 publication

Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

Role of S-100 stain for demonstration of different patterns of nerve changes in spectrum of leprosy – A prospective study

Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy

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