HPE OF LEPROSY

1. HISTOPATHOGENESIS OF
HANSEN’S DISEASE
BY:Dr. RASHMI SINGH
JR-1 ,SKIN&VD

2. IMPORTANT FEATURES

3. PATHOGENESIS

 Poor growth in culture, but grows in armadillo,
foot pad of mice.
 Has affinity for schwan cells of peripheral nerves due to :
 alpha2 laminin in basal laminin present in peripheral
nerves only.
 peripheral nerves being cooler are more affected .

4. FLOWCHART OF PATHOGENESIS

5. AFB IN ZIEHL NEELSEN STAINED
SLIDE

6. INDERMINATE LEPROSY:PERINEURAL
INFILTRATION OF LYMPHOCYTES AROUND
A DERMAL NERVE

7. HPE OF HANSEN’S DISEASE
• CAN BE DEALT WITH UNDER :
A.AGRANULOMATOUS which includes:
 Indeterminate leprosy
B.GRANULOMATOUS which includes :
 TT
 BT
 BB
 BL
 LL
 REACTIONS AND MISCELLANEOUS

8. INDETERMINATE LEPROSY
HPE:
 EARLY INDERMINATE LEPROSY:
 Occasional AFB either in non inflammed nerves ,erector
pylorum muscle or subepidermal zone.
 LATE INDERMINATE LEPROSY :
 Varying no. of lymphocytes in perineural sheath with few
AFB bacilli.
 Baton shaped nuclei with longitudinal orintation is
replaced by disoriented nuclei and loss of normal wavy
pattern of nerve.

9. LL: A WELL FORMED GRANULOMA
WITH NUMEROUS M.LEPRA
SINGLE AND IN CLUMPS

10. GRENZ ZONE SEPERATING
GRANULOMA FROM THINNED
EPIDERMIS

11. DIAGRAMATIC REPRESENTATION
OF LL GRANULOMA IN DERMIS

12. LEPROMATOUS LEPROSY
 Macrophage granuloma is hallmark.
 A strip of subepidermal zone AKA GRENZ ZONE
seperates granuloma from epidermis.
 Nerves are not infiltrated with either lymphocytes or
macrophages till late stage.
 Bacillii are innumerable with considerable no. of globi.

13. BL:BRANCHING GRANULOMA

14. BORDERLINE LEPROSY
Granuloma is predominantly of
macrophage type with few clumps of
epithelioid cells.
Mostly branching granulomas.
Lymphocytes are sparse.

15. BB:SHOWING ONION PEEL
APPEARANCE

16. MIDBORDERLINE LEPROSY
Admixture of equal number of
macrophage and epitheloid cells.
Scattered lymphocytes and less in no.
than epitheloid cells.
Subepidermal zone is clear.
Giant cells are absent diferentiating it
from BT.
Cut section of nerve shows onion peel
appearance.

17. BT:SHOWING GRANULOMA WITHOUT A
DISTINCT COLLAR OF LYMPHOCYTES

18. BORDERLINE TUBERCULOID
Epitheloid cell granuloma with admixture of few
macrophages.
Distinct collar of lymphocytes around epithelioid
granuloma is lacking.
Lymphocytes are moderate in no.with few giant
cells.
Nerves are replaced by granuloma.
Spurs of granuloma along course of nerve can be
seen.

19. TT:SHOWING GRANULOMA WITH A
DISTINCT COLLAR OF LYMPHOCYTES

20. TUBERCULOID LEPROSY
Characterised by epitheloid cell granuloma.
Has a tendency to erode a small chunk of epidermis.
Obliteration of subepidermal zone.
Compact focalized granuloma with mantle of dense
lymphocytes.
Granuloma may or may not show central caseation.
Nerve may be completely replaced by granuloma.

21. HPE SHOWING TYPE 1 REACTION

22. TYPE1 REACTION
 Infiltration of granuloma with neutrophils.
 Dilatation of lymphatics in upper dermis.
 Intense edema with seperation of collagen and pale
appearance of grranuloma.
 Macrophage differentiating to epitheloid cells.
 Influx of more lymphocytes.
 Disorganized granuloma called tissue panic.

23. HPE SHOWING TYPE2 REACTION

24. TYPE 2 REACTION
 Features of lepromatous granuloma.
 Acute inflammatory cell infilteration as neutrophils.
 Deposition of immune complexes in arterioles and
venules with resulting vasculitis.
 With increasing severity vessels are obliterated by
thrombosis .
 Finally ischemia and necrosis results.

25. MISCELLANEOUS
LUCIO PHENOMENON
HISTOID LEPROSY

26. HPE:SHOWS LEUCOCYTOCLASTIC
VASCULITIS AND FOAMY HISTIOCYTES

27. LUCIO PHENOMENON
 First described by RAFAEL LUCIO in 1851.
 Lucio leprosy presents with ulcerative skin lesions.
 Thrombosis of vesels leading to local ischemia and
ulceration called LUCIO PHENOMENON.
 Histology showsvasculitis ,thrombosis and neutrophilic
infiltrate.

28. HPE: SHOWING NUMEROUS HISTIOCYTES WITH
EOSINOPHILIC AND FOAMY CYTOPLASM

29. HISTOID LEPROSY
 First described by WADE in 1963.
 Presents as localized crops of shiny nodules.
 Nodules may be large and pedunculated.
 Histology shows hypercellular granuloma with spindle
shaped cells .
 Appears as a centrifugal ggrowth compressing fibrous
tissue into clear pseudocapsule.
 Cells are highly bacillated with predominantly solid
organisms.

31. REGRESSING LEPROSY
More appreciated in macrophage granuloma.
Decrease in no. of macrophage.
Cytoplasm of cell becomes foamy with SOAP
BUBBLE appearance.
Due to accumulation of fat from disintegrating
cells and bacilli.