Indian Journal of Dermatology
: 2021  |  Volume : 66  |  Issue : 2  |  Page : 179--186

A compendium of specific histopathological bodies in dermatology

Anup Kumar Tiwary1, Hiral Shah2, Bhushan Madke3, Piyush Kumar4,  
1 Consultant Dermatologist, Globax Healthcare Polyclinic, Noida, Uttar Pradesh, India
2 Department of Skin and Venereal Diseases, Baroda Medical College, Vadodara, Gujarat, India
3 Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
4 Department of Dermatology, Katihar Medical College, Katihar, Bihar, India

Correspondence Address:
Anup Kumar Tiwary
D-302, Jeevan Ashray Apartment, C 58/08, Sector 62, Noida, Uttar Pradesh


The spectrum of histopathological variations of most of the Dermatological conditions is so wide and overlapping that even with our current vast knowledge of this discipline, it seems to be a tough task for clinicians as well as Dermatopathologists to arrive at a conclusive diagnosis in many cases. However, with the aid of special stains and advanced diagnostic techniques, some characteristic histopathologic features have been defined over the time, among which histopathological bodies or inclusion bodies serve as specific clues. With this perspective in view, an attempt has been made to collate and describe the well-known as well as the lesser-known histopathological bodies seen in various dermatological diseases. The underlying pathogenesis and ultramicroscopic features of these structures have also been outlined in brief.

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Tiwary AK, Shah H, Madke B, Kumar P. A compendium of specific histopathological bodies in dermatology.Indian J Dermatol 2021;66:179-186

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Tiwary AK, Shah H, Madke B, Kumar P. A compendium of specific histopathological bodies in dermatology. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 1 ];66:179-186
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In many Dermatological diseases, there are some characteristic microscopic features which may be observed as striking alterations in the cellular and/or nuclear morphology, intracytoplasmic or intranuclear contents or deposits and changes in the spatial orientation of cells and the extracellular matrix. These changes may appear as “bodies or inclusion bodies,” necessitating detailed histopathological examination. A compilation of such bodies of dermatological interest are listed below in alphabetical order.

Angulate bodies: A special variety of lysosomes, which are angular in shape, membrane-delineated, and packed with microtubules, are referred to as angulate lysosomes.[1] These are most often found in histiocytes associated with the granular cells of granular cell tumor. It may also be found in Gaucher's disease[2]Apoptotic bodies: Are these and Civatte bodies same? These are degenerating or apoptotic basal keratinocytes undergoing chromatin aggregation, cell shrinkage, and disaggregation, followed by nuclear fragmentation and apical blebbing on the cell surface [Figure 1].[3] These homogeneous, eosinophilic bodies are often extruded into the papillary dermis to be called as colloid bodies. The common causes are lupus erythematosus (LE), lichen planus, interface dermatitis, graft versus host disease, erythema multiforme, drug reactions, and suprabasal acantholytic disorders[4]Alder-Rilley bodies: Deeply basophilic granules seen in neutrophils and sometimes lymphocytes and monocytes of bone marrow, in patients with mucopolysaccharide disorders such as Hurler's, Hunter's, and Maroteaux-Lamy syndromes. These appear to be lysosomes staining abnormally due to incompletely degraded mucopolysaccharides[5]Arao-Perkins bodies: These are clusters of elastic fibers formed within the lower part of follicular stellae like the rungs of a ladder during the catagen phase of a normal hair cycle and in androgenetic alopecia[6]Asteroid (stellate) bodies: Sometimes, small (3–5 μm), oval yeasts of Sporothrix schenckii may be surrounded by a thick, radiate, eosinophilic substance, which forms the asteroid bodies.[7] These are also seen in sarcoidosis in which they appear as star-shaped eosinophilic structures (10-15 μm). When it is stained with phosphotungstic acid-hematoxylin, produces a center that is brown-red with radiating blue spikes like an “open umbrella frame” [Figure 2][8]

Other conditions containing asteroid bodies include foreign body giant cell reactions, actinic granuloma, necrobiosis lipoidica, necrobiotic xanthogranuloma, fibroxanthosarcoma, and cystic teratoma[9]Banana bodies: These are yellow-brown or ochre colored, banana-shaped fibers in the papillary dermis due to the accumulation of homogentisic acid in alkaptonuria or following topical application of hydroquinone, resorcinol, phenol, mercury, or picric acid [Figure 3][10]Bollinger bodies: These are are large, granular, acidophilic, intracytoplasmic inclusion bodies observed in the infected epithelial cells of birds with avian pox.[11] These are aggregates of Borrell bodies and are pathognomic for fowl poxBorrel bodies: These are particles of the fowl pox virus, the aggregates of which form Bollinger bodies[12]Buschino/Buscaino bodies: These bodies are caused by prolonged submersion of tissue in formalin and appear as irregular cracks that contain small amounts of pale, bluish-gray amorphous material in hematoxylin and eosin stained tissue sections[13]Caterpillar bodies: In subepidermal blisters of porphyria cutanea tarda, the roof of the blister often contains periodic-acid-Schiff (PAS)-positive and diastase resistant eosinophilic bodies that are elongated and sometimes segmented resembling the larvae of butterflies. Ultrastructurally, these contain three components: (a) cellular organelles, including melanosomes, desmosomes, and mitochondria; (b) colloid that may be located intracellularly or extracellularly; and (c) electron-dense material thought to be of basement membrane origin.[14] Other conditions showing such bodies are bullous pemphigoid, junctional and dystrophic epidermolysis bullosa, and erythropoietic protoporphyria[15]Cigar bodies: In sporotrichosis, Sporothrix schenckii appear as faintly stained, elongated or cigar-shaped free yeast cells within histiocytes, measuring 2–6 μm or more[16]Civatte bodies (colloid, hyaline, or cytoid bodies): Homogeneous, periodic-acid–Schiff-positive and diastase resistant, eosinophilic rounded bodies of 10–25 μm in diameter, resulting from degeneration and apoptosis of keratinocytes, particularly in the lower layers of the epidermis [Figure 4]. They are found most commonly in lichen planus and other causes of interface dermatitis including graft-versus-host disease, lichen nitidus, LE, drug reactions, and in inflamed keratoses such as lichenoid actinic keratosis and lichen planus-like keratosis. They may even be observed in normal skin[3]Comma-shaped bodies: These are seen within the histiocytes, formed by two electron-dense membranes of approximately 6 nm, separated by a light space of about 8 nm.[17] The underlying conditions are benign cephalic histiocytosis, juvenile xanthogranuloma, and cutaneous T-cell lymphoma[18]Corp ronds and grains: These are dyskeratotic epidermal cells often observed in Darier's disease, Grover's disease, and warty dyskeratoma.[19] Corp ronds have a small pyknotic nucleus, a clear perinuclear halo, and brightly eosinophilic cytoplasm. Grains are small cells with elongated nuclei and scanty cytoplasm in the upper layers of the epidermis[17]Cowdry bodies: These intranuclear eosinophilic inclusion bodies are composed of nucleic acid and protein and are seen in cells infected with herpes, yellow fever, polio, and adenovirus. There are two types: Type A (in herpes infection and yellow fever) and Type-B (in infection with polio and adenovirus) Cowdry type-A inclusion bodies appear as droplet-like masses of acidophilic materials surrounded by clear halos within nuclei, with margination of chromatin on the nuclear membrane.[20] Type-B bodies are not associated with any nuclear changesDonovan bodies: In Klebsiella granulomatis infection, macrophages contain encapsulated bacilli within vacuoles, which are seen as short bacilli, either singly or in clumps with bipolar condensations on Warthin-Starry or Giemsa staining.[21]Dutcher bodies: These are periodic-acid–Schiff-positive pseudo-inclusions formed due to invagination of immunoglobulin-filled cytoplasm into the nucleus being surrounded by clumped chromatin.[22] Dutcher bodies are associated with Waldenstrom's macroglobulinemia, diffuse large B-cell lymphoma, multiple myeloma, and chronic synovitis.Elastic globe or bodies: These are defined as eosinophilic, PAS-positive, elastase sensitive, ovoid amorphous bodies of size 3–15 microns, stainable with Elastica van Gieson. They are located immediately below the dermoepidermal junction near the elastic network restricted to the face as well as to the extremities and regarded as morphological variants of the normal elastic fiber system.[23]Farber bodies: Are curvilinear, tubular structures in cytoplasmic vacuoles due to the accumulation of ceramide in the lysosomes, in patients with Farber's disease, having a deficiency of lysosomal acid ceramidase.[24]Flame figures: Intense pink, amorphous collagen encrusted with major basic protein from degranulated eosinophils, seen in Well's syndrome, insect bites, Churg-Strauss syndrome, and hypereosinophilic syndrome.[19]Gamna-Favre bodies: These are large basophilic inclusion bodies, composed of degenerated nuclear material, located in the cytoplasm of endothelial cells in lymphogranuloma venereum.[25]Glomus bodies: Glomus body is a special arteriovenous shunt or anastomosis formed without the interposition of capillaries that is seen in finger pads, nail beds, palms, and soles. Being located within the reticular dermis and concerned with temperature regulation, it comprises of an afferent arteriole, an anastomotic Sucquet–Hoyer canal, an efferent venule, the intraglomerular reticulum and its capsule. The Sucquet–Hoyer canals are lined by endothelial cells, which are surrounded by smooth muscle cells. Interspersed in the smooth muscle are the large cuboid glomus cells.[26]Golgi-Mazzoni bodies: Are encapsulated sensory nerve endings found in the subcutaneous tissue of the fingertips. They differ from Pacinian corpuscles in having thinner capsules, possessing fewer lamellae and containing fibers that are more extensively branched.[27]Guarnieri (Paschen) bodies: Cytoplasmic aggregations of variola virus particles, which are also found in vaccinia, monkeypox, and cowpox.[28]Gupta bodies: Also called “dust bunnies,” these are aggregates of filamentous, branching material with a woolly appearance with club formation at one end and seen in cervical smears in women, infected with Actinomyces israelii as a result of long-term use of intrauterine contraceptive devices.[29]Hematoxylin bodies (LE cells): These appear as basophilic extracellular aggregations of nuclear materials bound with immunoglobulins and are found in connective tissue diseases such as systemic lupus erythematosus.[30]Halberstaedter-von Prowazek bodies (Trachoma bodies): Are intracytoplasmic inclusions that vary in size from minute infectious elementary bodies to large metabolically active reticulate bodies. They represent the causal agent of trachoma.[31]Hamazaki-Wesenberg bodies (yellow bodies): Yellow-brown, ovoid inclusions of lipofuscins found in the sinus of lymph nodes that stain positive with PAS and methenamine silver. The most common condition is sarcoidosis, and others are appendicitis, colonic carcinoma, cirrhosis and lymphoid tumors.[32]Henderson-Patterson bodies: Are large, ellipsoidal, homogenous, intracytoplasmic proteinaceous inclusions found in the stratum spinosum and stratum corneum of skin infected with molluscum contagiosum [Figure 5].[20]Kamino bodies: Eosinophilic, red, globules with scalloped borders and crescent-shaped periphery present in the basal layer above the tips of dermal papillae are called “Kamino bodies” [Figure 6]. These are found in Spitz nevus and pigmented spindle cell nevus of Reed. The main content is type IV and type VII collagen which usually stain with PAS and Masson's trichrome stains.[33] Some authors also reported such bodies in malignant melanoma.[34]Lafora bodies: These are intracytoplasmic, basophilic and metachromatic, PAS-positive and diastase-resistant, concentric target-like laminated inclusions which are found in the skin (excretory sweat ducts), neurons, muscle cells, and hepatocytes in patients with Lafora body disease.[17]Leishman-Donovan (LD) bodies: In untreated patients of leishmaniasis, LD bodies appear as light blue, ellipsoid bodies, 2–4 μm long, with an eccentric nucleus and a smaller kinetosome at the opposite pole within large macrophages (Wright's cells) [Figure 7].[35]Lipschutz bodies: Are characterized by the presence of eosinophilic intranuclear inclusions with enlarged nuclei and clear halo in herpes simplex infection.[20]Mallory bodies: It consists of a delicate reticulum which stains light blue and the surrounding protoplasm pink. They are located intranuclearly within epidermal cells or within the lymphatic spaces.[17]Michaelis-Gutmann bodies: Round cytoplasmic inclusions of 5–15 μ size with lamellar appearance that stain positively with PAS, von kossa stain (for calcium) and Perl's ferrocyanide reaction (for ferric iron). They are considered pathognomonic for malakoplakia and are thought to represent the abnormal degradation of bacteria, with calcium and iron deposited on the remaining glycolipids.[36]Miyagawa bodies/corpuscles: Elementary, intracytoplasmic microcolonies of Chlamydia trachomatis found in lymphogranuloma venereum.[37]Odland/lamellar bodies: Also known as membrane coating granules, of size 100-300 nm in diameter and are found within the cytoplasm of cells of the upper spinous layer and granular cell layer. By discharging their lipid components into the intercellular space, they play important role in barrier function and intercellular cohesion within the stratum corneum.[4]Owl's eye inclusion bodies: Large intranuclear viral inclusion bodies with the thickened nuclear membrane in tissues, infected with the cytomegalovirus infection.[20] This appearance may also be seen in nuclei of Reed-Sternberg cells in patients with Hodgkin's lymphoma.Papillary mesenchymal bodies: Distinct fibroblastic aggregations around the basaloid islands representing the abortive attempts to form the mesenchyme of the dermal papilla around the hair bulb responsible for hair induction [Figure 8]. These bodies are generally associated with trichoepithelioma and trichoblastoma and helpful to differentiate these tumors from basal cell carcinomas[38]Pertinax bodies of Lewis and Montgomery: During the process of cellular differentiation with the expression and incorporation of trichocyte “hard” keratin in nails, their nuclei remain retained which are called “pertinax bodies”.[39]Psammoma bodies: Also termed as “sand bodies” or “corpora arenacea” which are commonly seen in cystadenocarcinoma of the ovary, papillary carcinoma of the thyroid, meningiomas, psammomatoid melanotic schwannoma, and juvenile ossifying fibroma.[40] On hematoxylin and eosin stained sections, these appear as spherical concentrically laminated mass of gritty, calcified materials.Pustulo-ovoid bodies of Milian: These represent the massive accumulation of lysosomal granules appearing as large, round eosinophilic granules surrounded by a clear halo and found in granular cell tumors [Figure 9].[41]Residual bodies: Residual bodies are tertiary lysosomes or also called as telolysosomes, seen as rounded, acidophilic membrane-bound bodies. It may either fuse with the cell membrane and complete the process of exocytosis, or may be retained in the cytosol to be called as lipofuscin granules. The macrophages and nerve cells have a high amount of residual bodies, especially in old nerve cells. In granular cell nerve sheath tumor, some of the perineurium infiltrating granular cells contain larger, rounded, acidophilic bodies called as the residual body.[42]Rushton bodies: Are present in odontogenic cyst and seen as intraepithelial, curvilinear and eosinophilic lamellar structures with granular core containing calcium and iron.[20]Russell bodies (also called Fuchsin bodies and Unna bodies): On demonstration with stains such as fuchsin, PAS or Grunwald-Giemsa stain, Russell bodies appear as eosinophilic, large, homogenous immunoglobulin inclusions measuring 20–40 μm within plasma cells. They are usually seen in multiple myeloma, Helicobacter pylori infection, periapical granuloma and plasmacytoma [Figure 10].[20]Schaumann (conchoid) bodies: In Sarcoidosis, these are seen as basophilic concentric lamellar structures, 100 μm in diameter, composed of lipomucoglycoproteins impregnated with calcium and iron, and they show central, bi-refringent crystals.[8]Sclerotic bodies: These are rounded cells with thick walls, also known as “Medlar bodies” or “copper pennies” found in chromoblastomycosis [Figure 11].[43] In another condition “nephrogenic systemic fibrosis” (occurring due to the administration of gadolinium contrast used during radiological imaging of patients with chronic renal failure), sclerotic bodies consisting of elastic fibres surrounded by coarse collagen can be found in thickened and hyperpigmented skin.Toto bodies: Are homogeneous, eosinophilic materials in the superficial spinous layer of the surface epithelium (termed as “plasma pooling”) which are preceded by mucopolysaccharide keratin dystrophy in response to inflammatory fibrous hyperplasia of the surface epithelium in conditions such as epulis fissuratum.[20]Thygeson bodies: Irregular elementary and reticulate bodies of Chlamydia pneumonia within reticuloendothelial cells.[44]Vater-Pacini bodies (Pacinian corpuscles): Are one of the major mechanoreceptors, sensitive to vibration and pressure found in the skin of the fingers and formed by concentric layers of connective tissue with a central soft core in which the nerves are located[45]Verocay bodies: Stacked arrangement of rows of elongated palisading nuclei alternating with acellular zones (made up of cytoplasmic processes of the Schwann cells and reticular fibres in between) found in schwannomas. Such an arrangement of nuclei is probably due to the over-expression of laminins in the cells in an adaptive response to maintain cell to cell interaction [Figure 12].[46]Vesicular bodies: Formed by fusion of flattened vesicles in the stratum dysjunctum and compactum (within stratum corneum) which maintain the patency of the intercellular space, and thus facilitates the absorption of applied substances by a form of shunt mechanism, as well as functioning as a reservoir.[47]Wagner-Meissner bodies: These are diffuse proliferation of nerve bundles in tactile corpuscles like pattern in the dermis, containing eosinophilic globules with parallel slits, typically seen in neurofibroma.[20]Winckler bodies: Spherical structures found in skin lesions in patients with syphilis.[48]Woronin bodies: Electron-dense, spherical, single membrane-bound proteinaceous inclusions found in close association with the septal pore in the filamentous ascomycetes and deuteromycetes fungi. In an emergency response to hyphal damage, these plug the septal pores preventing excessive loss of cytoplasm.[49]Zebra bodies: Classically seen in mucopolysaccharidoses (e.g., Hurler syndrome) and lysosomal storage disorders such as Fabry's disease, Niemann-Pick disease, Sandhoff's disease, and Tay-Sachs disease. Characteristically, these bodies appear as metachromatically staining membrane-bound lamellated granules with a 5.8 nm spacing in neurons, Schwann cells, macrophages, smooth muscle cells, endothelial cells, pericytes, glomerular epithelial cells, and hepatocytes.[50]{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}{Figure 9}{Figure 10}{Figure 11}{Figure 12}


The authors would like to thank Dr. Sherina Laskar for her help with reviewing the manuscript.

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