Clinical Significance and Histologic Characterization of Histoplasma Granulomas

Abstract Objectives To clarify the clinical significance and degree of resolution (ie, grade) of Histoplasma granulomas in routinely reviewed surgical pathology specimens and the clinical outcomes of patients with this diagnosis, with an emphasis on those not receiving antifungal therapy. Methods We...

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Bibliographic Details
Published in:American journal of clinical pathology 2021-04, Vol.155 (4), p.581-587
Main Authors: Demkowicz, Ryan, Procop, Gary W
Format: Article
Language:English
Subjects:
Antifungal agents
Antigens
Clinical significance
Diagnosis
Granuloma - etiology
Granuloma - pathology
Granulomas
Health aspects
Histoplasma
Histoplasmosis
Histoplasmosis - pathology
Humans
Laboratories
Medical records
Methenamine
Mycoses
Patients
Retrospective Studies
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Summary:Abstract Objectives To clarify the clinical significance and degree of resolution (ie, grade) of Histoplasma granulomas in routinely reviewed surgical pathology specimens and the clinical outcomes of patients with this diagnosis, with an emphasis on those not receiving antifungal therapy. Methods We performed a retrospective medical record, laboratory data, and surgical pathology slide review of patients with Histoplasma granulomas following institutional review board approval. Results Clinical, pathologic, and laboratory data from 62 patients with Histoplasma granulomas were available for review. Of these, 1 of 19 (5%) fungal cultures, 4 of 12 (33%) fungal serologic studies, 0 of 9 Histoplasma urinary antigen tests, and 0 of 2 Histoplasma serum antigen tests were positive. All but 3 of the Histoplasma granulomas were either in the resolving (grade 2) or resolved (grade 3) stage of resolution. None of the patients, including those who did not receive antifungal therapy after the histologic diagnosis, developed progressive or disseminated histoplasmosis. Conclusions These findings, which are supportive of clinical guidelines, suggest that patients with old, hyalinized Histoplasma granulomas do not benefit from further laboratory studies or antifungal therapy. The proposed grading of Histoplasma granulomas informs clinicians of the stage of resolution of an excised lesion, which informs therapeutic decisions and thus is recommended.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqaa159