Abstract
Introduction
Histoplasmomas are often found incidentally in surgical specimens, but there are no clear reporting guidelines to describe the subtle differences in the stages of organization of the granuloma. This study establishes grading criteria to more clearly communicate the stage of organization and resolution of these lesions, with the hope that this information could inform clinical decisions.
Methods
For an 11-year period, all surgical pathology cases with histoplasmomas in the final diagnosis with slides available were included in the study. After confirmation that Histoplasma yeasts were present, the granulomas were graded as
follows
grade 1, active granulomas with or without necrosis with minimal to no fibrous rim formation; grade 2, minimal to moderate granulomatous inflammation remained associated with a well-developed fibrous rim; and grade 3, no granulomatous inflammation remained, and a well-developed fibrous rim was present. Calcification and necrosis were also noted. Histoplasma yeasts was semiquantified. One to five yeasts were characterized as rare, 6 to 10 as few, 11 to 50 as moderate, and >50 yeasts as many.
Results
Forty-two cases were included in the study. The lesions were graded as
follows
3 grade 1, 19 grade 2, and 20 grade 3 lesions. Calcifications increased with grade (grade 1: 0 [0%], grade 2: 10 [52.6%], grade 3: 18 [95%]). All histoplasmomas had necrosis. The number of yeasts detected, stratified by grade, was as
follows
grade 1, rare (1) and many (2); grade 2, rare (6), few (1), moderate (1), and many (11); and grade 3, rare (2), moderate (4), and many (14). None of the patients developed active histoplasmosis for the duration of their follow-up at our institution.
Conclusion
The proposed grading of histoplasmomas provides an indication to clinicians of the stage of activity or resolution of an excised histoplasmoma. These data do not support the use of antifungal therapy in patients with grade 2 or 3 histoplasmomas.