Indian Journal of Dermatology
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Year
: 2014  |  Volume : 59  |  Issue : 1  |  Page : 106-

Subcutaneous cystic swelling on forearm


Momin Yasmin Altaf, Kulkarni Medha Pradeep, Deshmukh Bhakti Dattatraya, Sulhyan Kalpana Ranjitsingh 
 Department of Pathology, Government Medical College, Miraj, Maharashtra, India

Correspondence Address:
Deshmukh Bhakti Dattatraya
Department of Pathology, Government Medical College, Pandharpur Road, Miraj - 416 410, Maharashtra
India




How to cite this article:
Altaf MY, Pradeep KM, Dattatraya DB, Ranjitsingh SK. Subcutaneous cystic swelling on forearm.Indian J Dermatol 2014;59:106-106


How to cite this URL:
Altaf MY, Pradeep KM, Dattatraya DB, Ranjitsingh SK. Subcutaneous cystic swelling on forearm. Indian J Dermatol [serial online] 2014 [cited 2020 Aug 4 ];59:106-106
Available from: http://www.e-ijd.org/text.asp?2014/59/1/106/123551


Full Text

A 55-year-old woman presented with a gradually increasing painful forearm swelling since 1 year [Figure 1]. Physical examination revealed a cystic tender mass measuring 3.5 × 3 × 2.5 cm. The mass was mobile and distinct from surrounding structures. The cyst was excised with a probable clinical diagnosis of sebaceous cyst.{Figure 1}

On gross examination, the cyst was smooth surfaced and measured 3.5 cm in diameter. On opening the cyst was filled with yellowish material. Histopathology revealed a fibrocollagenous cyst wall [Figure 2] lined by well formed granulomas composed of multinucleated Langhan's as well as foreign-body type of giant cells and histiocytes admixed with dark brown yeast forms [Figure 3]. Few septate branched periodic acid schiff positive fungal hyphae were seen within the giant cells.{Figure 2}{Figure 3}

 Question



What is your diagnosis?

 View Answer

 Answer



Phaeohyphomycotic cyst.

 Discussion



Phaeohyphomycosis is a rare infection caused by dematiceous fungi whose hallmark is the presence of pigmented hyphae in tissues. [1] Subcutaneous infection results in cyst formation. The spectrum of disease ranges from superficial to emergent, rapidly fatal disease. [2] According to the site involved, it can be classified into subcutaneous, cutaneous, paranasal, and invasive systemic/cerebral phaeohyphomycosis. [3] Infection usually follows traumatic implantation from contaminated soil, thorns, and wood splinters. [1],[2],[3],[4],[5],[6] Very few cases have been reported in India distributed in a belt from north to south. [5]

Phaeohyphomycosis is generally seen in debilitated or immunodefecient hosts. [4] Indian patients with subcutaneous phaeohyphomycosis present at a younger age. [5] Average age range is 30-60 years, a male to female ratio of 1.3:1 has been reported with a prior history of injury. [1],[2],[3],[4],[5],[6] With implantation, the fungus grows in stratum corneum, in hairy areas it may grow in the hair shaft. The whole body may be covered with boils and bumps. Subcutaneous infection results in a single, discrete, well-encapsulated cyst with central necrotic area filled with pus. The surrounding granulomatous wall and multinucleated giant cells show hyphae with irregularly spaced branches and constrictions around the septae resembling pseudohyphae. [1],[2],[3],[4],[5],[6]

Differential diagnosis is cutaneous chromoblastomycosis which is a dematiaceous fungal organism with similar yeast forms, but has mauriform or copper penny appearance.

Cerebral chromoblastomycosis show hyphal forms, cutaneous forms show only yeast forms. Amongst phaeohyphomycosis, Phialophora jeanselmei, Phialophora spinefera, Phialophora dermatidis, and Phialophora richardsiae are common isolates. [6] P. jeanselmei is a dematiaceous organism that grows slowly (7-21 days) producing yeast-like colonies initially. With age colonies become filamentous, velvety and grey to olive to black. Treatment with newer azoles seems promising, and excision alone or combined with azoles is a good therapeutic modality. [5],[6]

References

1Mycoses and algal infections. In: Weedon D editor. Skin Pathology. 2 nd ed. Edinburgh: Churchill Livingstone; 2002. p. 673.
2Laboratory methods in basic mycology. In: Forbes BA, Sahm DF, Weissfeld AS, editors. Bailey and Scott's diagnostic microbiology. 12 th ed. St. Louis: Mosby Elsevier; 2007. p. 629-716.
3Phaeohyphomycosis. In: Chander J. editor. Textbook of Medical Mycology. 2 nd ed. New Delhi: Mehta Publishers; 2002. p. 147-53.
4Hinshaw M, Longlay BJ. Fungal diseases. In: Elder DE, Elenitsas R, Johnson BL Jr, Murphy GF, Xu X, editors. Lever's histopathology of skin. 10 th ed. New Delhi: Lippincott Williams and Williams; 2009. p. 601-3.
5Sharma NL, Mahajan V, Sharma RC, Sharma A. Subcutaneous pheohyphomycosis in India: A case report and review. Int J Dermatol 2002;41:16-20.
6Medical mycology. In: Ananthnarayan R, Panicker CK., editors. Ananthnarayan and Panicker's Textbook of Microbiology. 8 th ed. Hyderabad: Universities Press; 2009. p. 609.