El cuerpo asteroide de la esporotricosis. Especificad y diferenciación de otras formas de asteroides

Abstract

We analyzed 86 sporotrichosis biopsies and many others of varied granulomatous diseases. This study, and a review of the literature allow us to conclude that there are two different types of asteroid bodies: the first type is an intracytoplasmatic structure located inside of a vacuole, in multinucleated giant cells of diverse granulomatous diseases. They are eosinophilic and are formed by star-shaped spikes that radiate from an amorphous core. We illustrate them in lepromatous leprosy, sarcoidosis, paracoccidioidomucosis, lobomycosis, as well as in foreing body granulomas. All of them are morphologically identical, inespecific, and provide little help toward making a specific diagnosis. They originate by phagocytosis of collagen or by modifications of the cell center (59,60). The second type is the result of the so called Splendore-Hoeppli phenomenon which is considered to be an antigen-antibody reaction. The most conspicuous of these asteroid formations is found in sporotrichosis. It is extracellular and it is located at the center of the microabscesses of the mixed granuloma. It is formed by a central yeast surrounded by strongly eosinophilic spikes. It is morphologically characteristic, specific and helps to make the diagnosis of this disease. In our 86 cases, we found it in in 20% of the biopsies. Other authors who refer to this structure as . inespecific (47, 58, 61), have not taken into account its morphology or its pathogenesis. Asteroid structures of Splendore-Hoeppli phenomenon type can be seen in other mycosis, such as aspergillosis, systemic candidosis, paracoccidioidomycosis, lobomycosis and trycophitic granuloma. However its general morphology and histopathologic picture is quite different from that seen in sporotrichosis. It is possible to find the two structures in the same biopsy and the pathologist should be able to interpret the findings.