Basal cell carcinoma arising in a Leishmania scar

DNA methylation alterations caused by Leishmania infection may generate a microenvironment prone to tumour development

DNA methylation is an epigenetic signature consisting of a methyl group at the 5’ cytosine of CpG dinucleotides. Modifications in DNA methylation pattern have been detected in cancer and infectious diseases and may be associated with gene expression changes. In cancer development DNA methylation aberrations are early events whereas in infectious diseases these epigenetic changes may be due to host/pathogen interaction. In particular, in leishmaniasis, a parasitic disease caused by the protozoan Leishmania, DNA methylation alterations have been detected in macrophages upon infection with Leishmania donovani and in skin lesions from patients with cutaneous leishmaniasis. Interestingly, different types of cancers, such as cutaneous malignant lesions, lymphoma and hepatocellular carcinoma, have been diagnosed in patients with a history of leishmaniasis. In fact, it is known that there exists an association between cancer and infectious diseases. Leishmania infection may increase susceptibility to develop cancer, but the mechanisms involved are not entirely clear. Considering these aspects, in this review we discuss the hypothesis that DNA methylation alterations induced by Leishmania may trigger tumorigenesis in long term infection since these epigenetic modifications may enhance and accumulate during chronic leishmaniasis.

The Investigation of the Association of Cutaneous Leishmaniasis in Biopsy Specimens of the Patients with Granulomatous Disease and Skin Cancer Using the Molecular Method

Background

Clinically, cutaneous leishmaniasis (CL) can be confused with granulomatous diseases and skin cancers, and it may lead to erroneous diagnosis and treatment. Diagnosis based and histopathology can have some difficulties due to low number of parasites, especially in chronic CL cases. We aimed to emphasize the necessity of considering CL in the differential diagnosis for cases of granulomatous diseases and basal cell carcinoma, particularly in areas where CL is endemic.

Methods

One hundred and seven paraffin-embedded tissue biopsy specimens were selected from the archive, as of 2002, of Pathology Department, School of Medicine, University of Hatay Mustafa Kemal in Hatay, Turkey. After DNA isolation, performed with the samples were used for PCR analysis with specific 13A, 13B primers targeting kinetoplastid DNA (kDNA) found in all Leishmania species. Another PCR was performed with LITSR and L5.8S primers targeting ITS-1 internal-transcribed-spacer-1 (ITS-1) region to subtype positive samples. Then these samples were further analyzed for subtyping with PCR-RFLP using HaeIII enzyme (BsuRI).

Results

Ten out of 107 tissue specimens were positive via kDNA-PCR. Lupus vulgaris, sarcoidosis, skin lymphoma and Leishmania cutis appeared in 9 out of 10 positive specimens. One of the cases presented with a mass on the cheek and was pre-diagnosed with hemangioma, but leishmaniasis did not appear. All of 10 specimens were diagnosed as granulomatous dermatitis. Two out of 10 samples, found positive with kDNA-PCR, were analyzed with ITS-1-PCR and identified as L. infantum/donovani after RFLP.

Conclusion

Molecular methods should be utilized in the differential diagnosis of CL to eliminate false diagnoses of granulomatous diseases and skin cancers.

Leishmania infection: Misdiagnosis as cancer and tumor-promoting potential

Given the prevalence of cancer and leishmaniasis worldwide, the presence of these two pathologies in the same tissue sample may be merely fortuitous. The clinical outcome of both diseases is under the control of innate and adaptive immunity, and in both cases these progressive diseases are characterized by an impaired host Th1 response. As a consequence, the Th2 cytokine microenvironment occurring in progressive leishmaniasis may potentially promote tumor cell proliferation and vice versa. On the other hand, clinical aspects of subclinical cutaneous or visceral leishmaniasis sometimes closely resemble those observed in various neoplasms thus leading to misdiagnosis. In this review, we present recent findings on the association between leishmaniasis and malignant disorders. Our review includes HIV positive, HIV negative subjects and patients whose HIV status has not been established. Leishmaniasis mimicking a malignant disorder was confirmed and extended to unreported neoplastic disorders including squamous cell carcinoma, T-cell and B-cell lymphoma, oral and intranasal tumors and granulomas. Thus, leishmaniasis should be considered in the differential diagnosis and course of various cancers in Leishmania endemic areas or in patients with travel history to these areas. We also listed recent reports showing that Leishmania can promote cancer development in immunocompromised as well as in immunocompetent patients. The potential mechanisms supporting this promoting effect are discussed.

Cutaneous and mucocutaneous leishmaniasis: Clinical perspectives

Leishmaniasis is endemic in 98 countries and territories, with 1.2 million new cases per year, making it a worldwide concern. The deadly visceral form is a leading cause of death from tropical parasitic infections, second only to malaria. Leishmaniasis appears to be increasing in many countries because of extended urbanization. The disease reservoir includes small mammals; parasite transmission occurs via bite of the female phlebotomine sandfly. Disease manifestations vary and largely depend upon the Leishmania species acquired. It may be first evident with a range of findings-from a localized cutaneous ulcer to diffuse painless dermal nodules-or, in the mucocutaneous form, ulceration of the oropharynx. In the potentially deadly visceral form, the internal organs and bone marrow are affected.

Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil

BACKGROUND

Chromoblastomycosis (CBM) is a chronic fungal infection caused mainly by the melanized fungi Fonsecaea species. The chronic lesions may be predisposed to develop into cancer, the most serious complication of the disease.

METHODS

In this report, 7 cases of squamous cell carcinoma (SCC) resulting from chronic CBM in patients from Maranhão in the Brazilian Amazon are described.

RESULTS

The 7 patients presented with SCC that resulted from chronic CBM, caused by Fonsecaea species >10 years' duration. The malignant lesions occurred independent of the antifungal therapy and all patients underwent curative amputation, except for 1 patient who developed metastases in the inguinal and intra-abdominal lymph nodes and thigh muscles. A majority of previous reports have focused on the malignant transformation of CBM described in only 1 patient each. This is a first report describing a group of patients from a single Brazilian state.

CONCLUSIONS

Here, we provide new epidemiologic data on malignant CBM lesions, an endemic disease that is seemingly neglected worldwide. We reinforce the idea that typically chronic lesions may be predisposed to turn malignant.

Aspects of the association between leishmaniasis and malignant disorders

Given the prevalence of leishmaniasis and cancer, the co-existence of these two diseases may be merely coincidental. However, a number of epidemiological, experimental and laboratory studies suggest that an association between these two entities does exist. The aim of this review is to summarise the occurrence of leishmaniasis as an opportunistic infection associated with malignant disorders and to present the available literature potentially linking this infection with the development of cancerous lesions. We searched electronic databases and evaluated 37 studies involving 44 patients. Four different types of association between leishmaniasis and cancer were established: leishmaniasis mimicking a malignant disorder, such as lymphoma; leishmaniasis arising as a difficult to diagnose and treat infection among patients receiving chemotherapy for various malignant disorders; simultaneous diagnosis of leishmaniasis and a neoplastic disorder in the same tissue samples of immunocompromised patients; and direct involvement of Leishmania spp. in the pathogenesis/occurrence of malignant lesions, especially of the skin and mucous membranes. The main conclusion of this review is that leishmaniasis can directly or indirectly affect the presentation, diagnosis and course of various malignant disorders and it should be considered in the differential diagnosis of malignancies in geographic areas where it is endemic and/or in patients with travel history to these areas.

Leishmania scar: a risk factor for the development of basal cell carcinomas

Basal cell carcinoma is a malignant epithelial neoplasm of skin that usually arises in areas of chronic sun exposure. It rarely originates from smallpox vaccination scars, chickenpox scars, previous surgical scars, or burn scars. We present a case of basal cell carcinoma arising on a leishmania scar on the nasal dorsum 30 years after the primary lesion.

Increased DNA damage and oxidative stress in patients with cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is a chronic infectious and granulomatous disease caused by the Leishmania parasite that invades the skin. Reactive oxygen and nitrogen species (ROS and RNS) produced during an inflammatory response are an important part of host-defense strategies of organisms to kill the parasite. However, it is not well known whether these intermediates cause DNA damage in CL patients. We investigated the effect of Leishmania infection on basal levels of DNA strand breaks and on the oxidative/anti-oxidative status of patients with CL, and compared the data with those of healthy subjects. Twenty-five CL patients and 19 age- and sex-matched control subjects were enrolled in the study. We used the single-cell gel electrophoresis (also called comet assay) to measure DNA strand breaks in peripheral blood mononuclear leukocytes. Plasma protein carbonyl (PC), malondialdehyde (MDA) and total peroxide (TP) concentrations were measured to determine oxidative status and total anti-oxidative response (TAR) in plasma was measured to determine anti-oxidative status. The mean values of DNA damage and MDA and TP concentrations were significantly higher in CL patients than in the control group (p<0.001, p<0.01 and p<0.001, respectively). PC levels were also higher in patients, but this was not statistically significant (p>0.05). There was a significantly positive correlation between plasma MDA and DNA damage (r=0.524, p<0.01), and a negative correlation between TAR and TP levels (r=-0.790, p<0.001) in the patient group. These findings support the notion that ROS and RNS produced by the organism as a defense strategy may amplify the leishmanicidal activity in patients with CL. However, these intermediates not only cause the killing of the parasite but also induce oxidative damage in non-infected cells. Therefore, these patients must be treated urgently to counteract the oxidative DNA damage.

Squamous Cell Carcinoma Arising in a Leishmania Scar

BACKGROUND

The appearance of squamous cell carcinoma (SCC) in chronic scar lesions of various etiologies has been reported. Here we present a case of SCC developing in a Leishmania scar after 59 years.

OBSERVATIONS

An Iranian female presented with a SCC that arose when she was 3 years of age in a scar that was secondary to cutaneous Leishmania.

CONCLUSIONS

SCC should be included as a rare but late sequela of cutaneous Leishmania.

Extensive cutaneous leishmaniasis of the upper limb in a patient with leukemia

An unusual case of extensive cutaneous leishmaniasis of the upper limb in a patient with leukemia is presented. A trial of medical therapy (sodium stibogluconate) resulted in rapid healing of the large ulcers. The incidence of leishmaniasis is increasing globally as a result of the ease of travel and migrating populations. Hand surgeons worldwide should have a high index of suspicion of this parasitic infection of the upper limb and should be aware of its unusual presentation in immunocompromised patients.

Cutaneous leishmaniasis

The incidence of leishmaniasis is increasing globally due to population and environmental changes. Ease of worldwide travel and immigrant populations means that the UK surgeon is more likely to encounter cutaneous lesions. Two cases are presented and treatment options discussed.

Dermatofibroma parasitized by Leishmania in HIV infection: a new morphologic expression of dermal Kala Azar in an immunodepressed patient

Visceral leishmaniasis is a protozoan infection that may complicate the course of patients with human immunodeficiency virus (HIV). Dermatofibroma is a cutaneous fibrohistiocytic lesion considered neoplastic by some authors and inflammatory by others. Eruptive dermatofibromas have been described in patients with HIV infection or with other altered immunity situations. We present the case of a 32-year-old, HIV-positive man with visceral leishmaniasis who complained of the appearance of a cutaneous lesion in the leg formed by the coexistence of dermatofibroma and Leishmania parasitic colonization. As far as we know, this type of association has not been reported previously. We consider that the dermatofibroma could have developed as an unusual form of fibrohistiocytic reaction to leishmania. From a practical approach, we recommend the search of leishmaniasis in dermatofibroma in immunosuppressed patients.