Case Report: Squamous Cell Carcinoma Referred for Mohs Surgery Found to be Cutaneous Leishmaniasis

Overlapping between squamous cell carcinoma and mucocutaneous leishmaniasis in a diabetic patient

Mucocutaneous leishmaniasis (MCL) is a leishmania infection; that usually affects the oral and nasal mucosa. The coexistence of leishmania and malignancy is rarely reported and mainly in immunocompromised patients. We report a case of an overlapping between leishmania and squamous cell carcinoma (SCC) in a 60-year-old immunocompetent Syrian female. The patient presented with a one-year crusty nodule on the lower lip. Since she lives in an endemic region, leishmaniasis was suggested, and confirmed with a Giemsa-stained smear. After 20 days of meglumine antimoniate treatment, the patient revealed no signs of recovery, thus, the treatment was prolonged with the addition of sodium stibogluconate injections. Later, she presented with increased symptoms. A biopsy was performed due to SCC suspicion, and it was verified. The patient underwent complete surgical removal of the lesion. After a one-year follow-up, no recurrence was observed. We illustrated the importance of considering SCC in cases of refractory leishmaniasis.

Two cases of neglected leishmaniasis with marked facial disfigurement: A diagnostic conundrum

Key Clinical Message

There is a need to pay more attention to cutaneous leishmaniasis in endemic regions which may mimic other dermatoses and treatment should be initiated with a strong clinical suspicion even without any histopathologic or PCR confirmation to avoid disfigurement or development of secondary malignancy.

Abstract

Leishmaniasis is a vector-borne disease with a variety of Clinical manifestations. Cutaneous leishmaniasis (CL) is the most common form of disease and can mimic other dermatoses. We describe two unusual cases of chronic leishmaniasis that remained undiagnosed for many years and led to superimposition of squamous cell carcinoma (SCC) on lesions of one patient. These reports showed that the leishmaniasis should be borne in mind by clinicians when encountering any infiltrated lesion in patients from endemic regions and treatment should be initiated with a strong clinical suspicion even without any histopathologic or PCR confirmation to avoid disfigurement or development of secondary malignancy.

Squamous cell carcinoma superimposed on mucosal leishmaniasis in an HIV-positive patient

Leishmaniasis is emerging as an important problem in immunosuppressed individuals, leading to overt clinical disease, atypical presentation, chronic course, and impaired treatment response. Moreover, it can affect unexposed regions and strikingly mimic other infectious disorders and a variety of neoplastic diseases, thus being easily misdiagnosed. Here, we report the case of an HIV-patient where both clinical picture and histopathological findings were consistent with mucosal leishmaniasis (ML). However, the worsening of the clinical picture after anti-leishmania treatment led to suspect a different diagnosis, and squamous cell carcinoma superimposed on ML and Human Papilloma Virus infection was ultimately diagnosed.

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.