Oral presentation on Clinico-histopathological profile of dermatological disorders - A study at tertiary care teaching hospital centre in Pondicherry by Dr.Varughese George

1. CLINICO-HISTOPATHOLOGICAL
PROFILE OF DERMATOLOGICAL
DISORDERS : A STUDY AT A
TERTIARYCARE TEACHING
HOSPITALCENTRE IN
PONDICHERRY
DR. VARUGHESE P GEORGE
(Post Graduate)
DR. ANANDRAJ VAITHY K
(Associate Professor)
DR. SOWMYA S
(Professor & H.O.D)
INSTITUTE: DEPARTMENT OF PATHOLOGY, MGMCRI, PONDICHERRY

2. INTRODUCTION
 Skin, the largest organ of human body is extraordinarily vibrant with
regard to diversity and complexity of the function it serves.
 The incidence of dermatological lesions is high among tropical
countries like India and the spectrum varies significantly with
geographical distribution and co-existing disorders.
 Histopathological study of the biopsy tissue remains the mainstay for
diagnosis of skin lesions.
 Skin lesions should be analyzed and categorized on histology
according to socio-demographic domain to arrive at correct diagnosis.

3.  Literature states judicious clinico-pathological correlation for
skin disorders is essential for internal quality system as well as
for treatment prognosis especially among tropical countries like
India.
 Majority of such available meta-analytic studies were carried
on northern parts of the country and very sparse studies are
available on eastern coastal regions covering both non-
neoplastic and neoplastic lesions.
INTRODUCTION

4. AIM
 To analyze the histopathological profile of skin lesions in
biopsies in east-coastal population of our set-up, thereby to
study the most prevalent type.
 To evaluate the clinico-pathological correlation among the
studied cases as a part of quality assurance system.

5. METHODOLOGY
 A five year observational cross–sectional study was carried on
for a period of 5 years in the Department of Pathology, Mahatma
Gandhi Medical College and Research Institute, Pondicherry.
 Total number of 510 cases of dermatological lesions with
subsequent available biopsies were studied.
 Necessary clinical details were obtained in a proforma.
 The slides were sectioned and stained for evaluation as per SOP
of our department.
 The data obtained were tabulated for analysis.

6. RESULTS
 Among 510 cases analyzed,
82%
18%
Type of dermatological lesions
Non neoplastic
neoplastic

7. GENDER DISTRIBUTION
FEMALE
49%
MALE
51%

8. AGE DISTRIBUTION
0
10
20
30
40
50
60
70
80
90
1-15 16-30 31-45 46-60 61-75 76-90
F
M

9. NON-NEOPLASTIC SKIN LESIONS
INFECTIOUS &
IMMUNE-MEDIATED
INFLAMMATORY
•Leprosy(n=54)
•Lupus Vulgaris(n=8)
•Chromoblastomycosis
(n=1)
•Madura mycosis(n=1)
•Parasitic infection(n=1)
INFECTIOUS
Granulomatous
INFECTIOUS
Non-Granulomatous
•Lichen Planus (n=39)
•Chronic non- specific
dermatoses(n=33)
•Pityriasis(n=28)
•Psoriasis(n=20)
•PMLE(n=6)
•Pyogenic granuloma(n=6)
•Calcinosis cutis(n=5)
•Irritant contact
dermatitis(n=5)
•Pyoderma
gangrenosum(n=4)
•Granuloma annulare(n=4)
•Juvenile
Xanthogranuloma(n=1)
•Prurigo(n=2)
•Foreign body granuloma
(n=1)
IMMUNE-MEDIATED
•Leucocytoclastic
vasculitis(n=30)
•Vesicobullous
lesions(n=20)
•Morphea(n=15)
•Lupus
erythematosus(n=9)
•Amyloidosis(n=4)
•Scleroderma(n=4)
•Verruca vulgaris(n=6)

10. NEOPLASTIC SKIN LESIONS
BENIGN
Tumours with apocrine and eccrine
differentiation
•Eccrine poroma(n=3)
•Hidradenoma(n=2)
•Syringoma(n=2)
Melanocytic tumours
•Intradermal naevus(n=5)
•Compound naevus(n=3)
•Congenital melanocytic naevus(n=1)
•Lentiginous junctional naevus(n=1)
•Epidermal naevus(n=1)
Tumours with follicular differentiation
•Pilomatricoma(n=5)
•Proliferating trichilemmal cyst(n=3)
•Trichoepithelioma(n=1)
Acanthomas
•Keratoacanthoma(n=1)
•Seborrhoeic keratosis(n=4)
Tumours with sebaceous differentiation
•Nevus sebaceous(n=1)

11. NEOPLASTIC SKIN LESIONS
BENIGN MALIGNANT
Tumours with Apocrine and Eccrine
differentiation
•Eccrine ductal carcinoma(n=2)
Keratinocytic Tumors
•Basal cell Carcinoma(n=11)
•Verrucous squamous cell carcinoma (n=2)
•Bowenoid papulosis(n=4)
Tumours with follicular variation
•Pilomatrix carcinoma(n=1)
Tumours with sebaceous differentiation
•Sebaceous Carcinoma(n=1)
Melanocytic tumours
•Malignant melanoma(n=9)
Cutaneous Lymphomas
•Mycosis fungoides(n=2)

12. CLINICO-PATHOLOGICAL
CORRELATION (CPC)
0
20
40
60
80
100
120
Hyperpigmented
patch/plaque
Hypopigmented
patch/plaque
Scaly, erythematous
lesions
Itchy plaques Nodules/cystic
lesions
Other non-specific
lesions
n=38
n=48n=46
n=31
n=34
n=97

13. Correlation Non- Neoplastic Lesions Neoplastic Lesions
Infectious
(n)
Inflammatior
y
(n)
Immune-
mediated
(n)
Benign
(n)
Malignan
t
(n)
CPC Agreement 128 121 93 22 19
CPC
Disagreement
23 29 11 9 8
Inconclusive 18 13 9 2 5
Total (n=510)
CLINICO-
PATHOLOGICAL
CORRELATION (CPC)

14. HISTOID HANSEN'S
DISEASE

15. KERATOACANTHOMA

16. MALIGNANT MELANOMA

17. CUTANEOUS AMYLOIDOSIS

18. DISCUSSION
 Analysis of broad categories revealed non-neoplastic lesions
constituted the major group among which inflammatory lesions
ranked the top, concurring with prior literatures.
 Leprosy of all types was the most common cause for infectious
granulomatous lesions followed by tuberculosis in accordance with
observations of Chakrabarti S etal and Gautam K etal.
 Pre-malignant and neoplastic lesions were predominantly seen
in elderly age group.
 Atopic dermatitis was the commonest lesion noted in the
pediatric age group concurring with studies done by AlKhater et
al in this zone of study.

19.  Vesiculobullous lesions category of non-neoplastic skin disease
showed high clinico-pathological correlation as all the presented
cases showed classical pattern obviating the need for expensive
immunofluorescence.
 Lichenoid lesions were the most common histopathological
diagnosis reported among inflammatory lesions with lichen planus
being the most common histopathological subtype of lichenoid
lesions.
 The lesions which did not represent the typical histopathological
picture of any condition hence they were reported as chronic non-
specific dermatoses.

20.  Interestingly few cases show significant number of
neoplastic cases occuring among young females, warranting
a matter of concern to be addressed in eastern coastal
population.
 Among the carcinoma category, basal cell carcinoma ranked
the top followed by squamous cell carcinoma (with prior
premalignant lesion sequence).
 Clinicopathological correlation was significant with regard to
melanocytic tumours relatively as compared to non-
melanocytic type .

21. CONCLUSION
 The incidence of skin lesions in study population was higher than
assumed especially in the middle age group among the eastern
coastal population with prevalence of non–neoplastic and neoplastic
skin disease increasing with age.
 Granulomatous dermatitis is still rampant with leprosy and
tuberculosis as the leading causes in spite of awareness and
preventive measures.
 In cases where skin biopsy delivered a non-specific diagnosis,
infective or neoplastic etiology was ruled out.
 Larger multi-center histopathological studies are needed to help
assess the pattern of skin diseases based on pathological evaluation
to develop public health strategies and to have clinicopathological
correlation as a part of internal quality assurance.

22. REFERENCES
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Histopathological study of dermatolological lesions – A
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23. REFERENCES
5. Chakrabarti S, Pal S, Biswas BK, Bose K, Pal S, Pathak S.
Clinico-pathological study of cutaneous granulomatous
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24. THANK YOU