T H E AMERICAN JOURNAL OF CLINICAL PATHOLOGY
Vol. 39, No. 6, pp. 598-006
June, 1963
Copyright © 1963 by The Williams & Wilkins Co.
Printed in U.S.A.
CHRONIC SUBCUTANEOUS ABSCESSES CAUSED BY P I G M E N T E D
FUNGI, A LESION DISTINGUISHABLE FROM CUTANEOUS
CHROMOBLASTOMYCOSIS
RICHARD L. KEMPSON, M.D., AND WILLIAM H. STERNBERG, M.D.
Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana
Chromoblastomycosis is a chronic granulomatous inflammatory disorder caused by
strains of brown pigmented fungi known as
the dematiaceous fungi. In the usual form of
the disease, cutaneous chromoblastomycosis,
the lesions are limited to the skin and
represent a well established clinical and
histologic entity. Within recent years,
however, there has been an increasing
number of cases reported in which the
dematiaceous fungi have been isolated from
extracutaneous lesions. During the past 6
years we have encountered 7 examples of
single, subcutaneous abscesses containing
pigmented fungi that are histologically
similar to the dematiaceous fungi. These
lesions, unlike those of cutaneous chromoblastomycosis, were confined to the subcutaneous tissue and did not involve the
skin. The inflammatory reaction, however,
was similar to that of cutaneous chromoblastomycosis. Clinically these abscesses
presented as small asymptomatic encapsulated cystic masses on the extremities, with
no satellite or cutaneous lesions. Preoperatively, they were diagnosed as sebaceous cysts, foreign body granulomas, or
tendon sheath ganglions, and no cultures
were obtained at the time of operation. In
reviewing the literature, we have been unable
to find reports of similar subcutaneous
lesions, with the possible exception of 1
case report by Young and Ulrich in 1953.18
The
causative
organisms of
cliromo-
Received, June 4, 1962; revision received,
November 13; accepted for publication March 1,
1963.
Dr. Kempson was Instructor in Pathology,
Tulane University School of Medicine, and his
present address is Department of Surgical Pathology, Barnes Hospital, 600 South Kingshighway,
St. Louis, Missouri. Dr. Sternberg is Professor of
Pathology, Tulane University School of Medicine,
New Orleans, Louisiana.
blastomycosis are classified among the
fungi imperfecti, generally in the genus
Hormodendrum (Cladosporium) or genus
Phialophora. The exact classification of
these organisms is confused, inasmuch as
they may manifest, within a single pure
culture, the sporulation pattern regarded as
characteristic of several different species. 3,4
The 3 most common fungi isolated from
skin lesions in cutaneous chromoblastomycosis are known as Hormodendrum
pedrosoi, Cladosporium carrionii, and Phialophora verrucosa; however, other members of
the genus Hormodendrum have been isolated
from lesions in man, and some of these
lesions have been found in organs other than
the skin. Thus, chromoblastomycosis can no
longer be regarded as one of the mycoses
limited to the skin. In the remainder of this
paper the term Hormodendrum species will
be used in referring to the etiologic agents of
chromoblastomycosis, with full realization
that other closely related pigmented fungi,
such as Phialophora may occasionally be
responsible for the lesion.
The fungi of the Hormodendrum species
are ordinarily saprophytic on vegetable
matter and are introduced into the human
skin as incidental contaminants following
minor trauma. Several species have been
isolated from wood and wood pulp, and II.
pedrosoi has been grown on autoclaved
plant leaves.12,14 Evidently, the organisms
are carried passively into the skin by
splinters of vegetable matter or by contamination of wounds with infected material.
Chromoblastomycosis in its usual cutaneous form begins as a small papule or
warty growth on the extremities and
advances by the production of satellite
growths, apparently resulting from direct
regional extension of the organisms. The
lesions progress slowly and after a time may
coalesce to form extensive, confluent,
598
FIG. 1 {upper left). Case 2. Typical subcutaneous abscess caused by chromoblastomycosis without
involvement of upper dermis or epidermis. Hematoxylin and eosin. X 8.
FIG. 2 {upper right). Case 5. Cluster of organisms within the wall of a subcutaneous abscess. Note
numerous organisms present as sclerotic bodies. Periodic acid-Schiff. X 460.
FIG. 3 {lower left). Case 3. Detailed structure of beadlike hyphal fragments. Similar hyphae were
found in all cases. Periodic acid-Schiff. X 1300.
FIG. 4 {lower right). Case 6. Detailed structure of sclerotic bodies, illustrating thick cell walls and
cytoplasmic septation. This form of the organism was found in all cases. Periodic acid-Schiff. X 1300.
599
600
KEMPSON AND STERNBERG
papillomatous growths that are often
tumor-like and keratinized. On microscopic
examination the epidermis reveals a striking
acanthosis and hyperkeratosis. These characteristics are not seen in the subcutaneous
lesions present in our cases.
The various causative agents of cutaneous
chromoblastomycosis, such as H. pedrosoi,
H. compactum, and P. verrucosa, can not be
distinguished in tissue sections, inasmuch
as the tissue phase is the same for all of
them. The organisms are seen microscopically as dark brown or olive, crescentshaped or rounded bodies with dark, thick
cell walls. The brown pigmentation is not
the result of staining and is equally apparent
in unstained sections. These structures are
chlamydospores or the so-called "sclerotic"
or "septate" bodies. They occur either singly
or in groups of 2 to 6 or more and may be
found in the cytoplasm of giant cells, in
tissue, or free in the purulent exudate of
epithelial or dermal microabscesses. Budding
or hyphal forms are rarely seen.4 Multiplication of the organisms in tissue takes
place primarily by fission along cytoplasmic
septums. These cytoplasmic septums are
black to dark brown thick lines that divide
the cell in 1 or 2 planes. Identical chlamydospores or septate bodies are seen in the
subcutaneous lesions in our cases, but in
addition, hyphal forms are also present.
REPORTED CASES OP DEEP LESIONS
OP CHROMOBLASTOMYCOSIS
As mentioned previously, organs other
than the skin may be parasitized by pigmented fungi of the Hormodendrum species.
In general the inflammatory reaction within
these other tissues is similar to that seen in
cutaneous chromoblastomycosis. In some of
the cases of deep tissue disease, the organisms
isolated have been 1 of the 3 species usually
cultured from skin lesions; in others, the
organisms have been other members of the
Hormodendrum species.
The first case of deep tissue disease was
reported in 1933 from Puerto Rico by
Carri6n and Koppisch.6 They found subcutaneous abscesses of the leg without skin
involvement in a patient who had cutaneous
chromoblastomycosis of the opposite leg and
Vol. 39
of the blood vessels. Since that time there
have been several reports of lymphatic
involvement and even elephantiasis in
cases of extensive cutaneous chromoblastomycosis.5' 17 In 1948, Lewis and associates11
reported a case of subcutaneous fungal
abscess of the hand occurring secondary to
traumatic introduction of wood splinters.
The lesion was fluctuant and did not involve
the skin except for draining sinuses. Histologically the inflammatory reaction was
similar to that seen in cutaneous chromoblastomycosis but, unlike chromoblastomycosis, black pigmented fungi were present
as septate filaments and granules. The
authors thought the organisms, although
difficult to classify in culture, were members
of the Hormodendrum species. Emmons,
however, classified the organisms as Torula
jeanselmei. In 1953, Young and Ulrich18
reported a single case of asymptomatic
subcutaneous abscess containing brown
pigmented fungi present as septate bodies
and branching chains. In culture the organism was identified as Sporotrichum
gougeroti, a species that Carrion and Silva7
have reclassified as Cladosporium gougeroti.
The tissue phase of these fungi was similar
to that observed in our 7 cases. In 1957,
Fukushiro and co-workers9 in Japan reported a case of cutaneous chromoblastomycosis of the face in which the organisms
metastasized to the brain. Hyphae as well
as sclerotic bodies were found in tissue
sections of both the skin and brain lesions.
H. pedrosoi was cultured from the skin and
from the brain lesions.10
In 1960, Symmers17 described a case of
chromoblastomycosis limited to the nasal
mucosa in a man from Ceylon. In 1961,
Sasono and colleagues15 reported from
Japan the case of a 3-year-old child who
chewed and smoked tobacco and died with
invasion of multiple internal organs by
brown pigmented fungi histologically similar
to the Hormodendrum species. Within the
past 12 years there have been at least 18
cases reported of brain abscess caused by
pigmented fungi. 1,2 - 8i 13 ' 16 In many of the
cases a newly classified species of pigmented
fungi, C. trichoides, has been isolated. The
tissue phase of this species is similar to the
June 196S
ABSCESSES CAUSED BY PIGMENTED FUNGI
organisms isolated from cutaneous chromoblastomycosis, except that beadlike branched
pigmented hyphae can be identified as well
as the typical septate sclerotic bodies. The
route of entry of these organisms into the
central nervous system has never been
determined, but it is interesting to note that
the tissue phase of the organisms found in
the subcutaneous abscesses in our 7 cases is
identical to the tissue phase of C. trichoides
isolated from brain abscesses. In both
lesions, unlike most cases of cutaneous
chromoblastomycosis, hyphae as well as
septate sclerotic bodies were found.
601
FIG. 5. Case 3. Two sclerotic bodies. Note
that the body on the left shows cytoplasmic
septation in 2 planes. Hematoxylin and eosin.
X 685.
BEPOET OP CASES
The following case reports present 7 new
examples of subcutaneous abscess produced
by fungi histologically similar to the
Hormodendrum species but not accompanied
by the usual cutaneous lesions of chromoblastomycosis.
Case 1. E.P., a 49-year-old colored male
fruit peddler from New Orleans was seen in
the surgical clinic of Charity Hospital in
May 1956 with a fluctuant asymptomatic
subcutaneous mass of 3 months duration on
the right hand. The epidermis was not
involved. The mass was excised under local
anesthesia and ruptured during removal, so
that the sebaceous-like contents were
spilled. The wound was closed, and the
patient subsequently developed a wound
infection that healed after hot soaks and
penicillin. The patient also had had 3
cerebral vascular accidents, the first at age
20, as well as diabetes mellitus. Angiogram
in July 1959 revealed blockage of a branch
of the left middle cerebral artery. He continues to be seen in the metabolic clinic and
has had no recurrence or new fungal lesions.
Grossly the tissue was a collapsed, opened
cystic structure measuring 2.0 by 1.5 cm.
Microscopically, sections revealed a fibrouswalled cyst containing within its center
necrotic debris that blended into an area of
dense granulomatous inflammation next to
the fibrous wall. The granulomatous exudate
was composed of histiocytes arranged in an
epithelioid fashion, lymphocytes, and giant
cells of both the foreign body and Langhans'
type. The cyst was present within sub-
cutaneous tissue and extended to the lower
dermis, but the upper dermis and epidermis
were not involved. Within the areas of
granulomatous inflammation and in the
necrotic debris were numerous brown pigmented fungi. Many of these organisms were
present as clusters of sclerotic bodies with
double-layered walls and septate cytoplasm.
Some of the organisms were present in
beadlike branching hyphal chains. There was
great variation in size and shape of the
organisms. The PAS and Gridley technics
stained the fungi a brilliant red.
Case 2. L.E., a 61-year-old colored
woman, a farmer's wife from Port Allen,
Louisiana, was admitted to Charity Hospital
in October 1954 because of severe congestive heart failure, hypertension, and
diabetes mellitus. She had a subcutaneous
mass 1 by 1 cm. on the ventral aspect of the
left forearm. This was asymptomatic, and
the patient did not know how long it had
been present. It was removed under local
anesthesia and the wound healed well.
There was no recurrence.
Grossly the specimen was a fibrous-walled
cyst containing a cheesy yellow material.
Microscopically there was a subcutaneous
abscess lined by fibrous tissue and containing necrotic debris and many polymorphonuclear leukocytes in the center.
Next to the fibrous wall were sheets of
macrophages without epithelioid arrangement. Giant cells were not seen. Within the
necrotic debris and in the granulomatous
reaction around the periphery were numerous brown pigmented fungi present in
602
KEMPSON AND STERNBERG
clumps as sclerotic bodies and also as
branched hyphae. The hyphal forms predominated. The epidermis and dermis were
not involved.
Case 3. M.S., a 56-year-old colored
female domestic from Baton Rouge,
Louisiana, was seen in the tumor clinic of
Charity Hospital in May 1956 because of a
mass on the volar surface of the left index
finger at the junction of the first and second
phalanges. The lesion had been present for
approximately 1 year, was painless, but had
gradually enlarged in size. The mass was
attached to the skin, but the surface of the
skin was not involved. The lesion was
excised under local anesthesia, and the
wound healed completely. The patient was
last seen at Charity Hospital in March
1957, at which time there had been no
recurrence or new lesions.
Past history revealed that the patient
had chronic renal disease of unknown
etiology and severe congestive heart failure.
Grossly the mass was cystic, containing
yellow necrotic material and a long fiber,
apparently of vegetable origin.
Microscopically there were fragments of
dense connective tissue lined by a layer of
dense granulomatous inflammatory tissue.
Scattered throughout the zone of granulomatous reaction were numerous brown
pigmented fungi present as beadlike branching hyphal chains and as single and grouped
sclerotic bodies with thick walls and cytoplasmic septation.
Case 4- M.C., a 42-year-old colored
woman from New Orleans employed as a
shrimp cleaner, was seen in the surgery
clinic of Charity Hospital in December
1959, with a firm, nontender, freely movable
nodule under the skin of the palm overlying
the flexor tendons of the left fifth finger.
The patient had first noticed the lesion 4
days previously. The clinical diagnosis was
ganglion or giant cell tumor of tendon
sheath. Under radial, ulnar, and median
nerve block, a yellow cystic mass was
excised. During removal the cyst ruptured
and a xanthomatous material from the cyst
spilled into the wound; however, the wound
healed completely without complication.
The patient had been a diabetic since
Vol. 89
1950, but was controlled well with Orinase.
She was last seen at Charity Hospital in
August 1960, and there was no recurrence
of fungal lesions.
Grossly the lesion was a firm, grey-white
structure that was cystic on sectioning and
contained a yellow cheesy material.
Microscopically the cyst was similar to
those noted above; brown pigmented fungi
were present as sclerotic bodies and as beadlike branching hyphae. Septation of the
sclerotic bodies with apparent splitting was
prominent. The center of the abscess was
composed of necrotic debris.
Case 5. M.W., a 49-year-old colored farm
housewife from St. Helena Parish, Louisiana,
was seen at the Lallie Kemp Charity
Hospital in June 1959 complaining of a
lump on the left leg that had been present
for 2 weeks. The lesion was painless and on
examination was described as a subcuta
neous mass on the lateral surface of the
lower third of the left leg, 3 cm. above the
lateral malleolus. It seemed to move with
inversion and eversion of the foot and was
attached to fascia. The mass was excised
while the patient was under local anesthesia, and postoperatively the wound
healed well. The patient was last seen in
May 1960 and at that time had had no
recurrences or new fungal lesions. There
is no past history of medical or surgical
illnesses. Grossly the mass was yellow in
color and surrounded by a definite fibrous
capsule. The contents were partially calcified.
Microscopically the changes were similar
to those noted previously, although the
typical brown fungi were less numerous and
calcified debris was present.
Case 6. B.M., a 65-year-old colored male
farmer from Independence, Louisiana, was
seen at the Lallie Kemp Charity Hospital in
July 1960 complaining of a painless swelling
that had been present for 2 months over the
volar side of the dorsal surface of the left
wrist. Examination revealed a small, round,
encapsulated mass that was thought to be a
ganglion. The lesion was excised under local
anesthesia, and the wound healed without
complications. There was no past history of
medical or surgical illness. The patient was
June 1963
ABSCESSES CAUSED BY PIGMENTED FUNGI
discharged from the clinic in September
1960, and there had been no recurrence or
further lesions at that time.
Grossly the cystic mass was firm to
palpation, grey on its external surface, and
yellow-brown and soft on cut section.
603
Microscopically the specimen was a
fibrous-walled cystic structure within the
subcutaneous tissue. The epidermis was
uninvolved. Within the cyst was a typical
granulomatous inflammation containing epithelioid cells, and giant cells of both the
F I G . 6 (upper). Case 0. Granulomatous inflammation with noncaseating tubercle
formation. Note giant cells. Hematoxylin and eosin. X 145.
F I G . 7 (lower). Case 5. Four organisms located in positions "12 o'clock" to
" 2 o'clock" on periphery of giant cell. T h e y have a natural brown pigmentation
in unstained, and in hematoxylin and eosin preparations. Hematoxylin and
eosin. X 1300.
604
KBMPSON AND STERNBERG
foreign body and Langhans' type. The
histiocytes were arranged in a tubercle-like
structure without caseation. Typical brown
pigmented fungi as described above were
present in large numbers.
Case 7. L.D., a 39-year-old colored farm
housewife from Lacombe, Louisiana, came
to the Charity Hospital surgical clinic in
May 1962, complaining of a painless "knot"
on her right middle finger. The clinical
diagnosis was "lipoid cyst," and the lesion
was excised under local anesthesia. Sutures
were removed one week after excision, at
which time the wound had healed well.
Grossly the specimen was a portion of a
fibrous-walled subcutaneous cyst attached
to an elliptically shaped piece of skin.
Microscopically the periphery of the cyst
presented a dense, granulomatous, inflammatory process similar to that found
previously. Brown pigmented fungi were
numerous, and both hyphae and sclerotic
bodies were present. There were large
numbers of acute inflammatory cells scattered diffusely throughout the infiltrate. A
small number of microabscesses were noted.
DISCUSSION
Chromoblastomycosis is often thought to
be a fungous disease limited to the skin, but
the cases presented here re-emphasize that
the disease may affect the deeper tissues
without associated cutaneous involvement.
It is unfortunate that cultures were not
obtained from these subcutaneous lesions,
but it is understandable, inasmuch as
fungous infection was not considered in the
original differential diagnosis. Thus the
exact identification of the organisms can
not be established, although the presence of
clusters of brown fungi with septate divisions
of the cytoplasm leaves little doubt that
they belong to the Hormodendrum species.
The presence of long beadlike hyphal chains
as well as sclerotic bodies in all of our cases
is suggestive of the tissue phase of C.
trichoides, which has been isolated from
some of the examples of mycotic brain
abscess previously mentioned. Bobra2 has
stated that no fungus other than C. trichoides has been described that produced
pigmented septate round bodies and pig-
Vol. 39
mented hyphae in tissue. It is impossible,
however, to rule out completely other
members of the Hormodendrum species in
histologic sections alone. This is well
documented in the case reported by
Fukushiro and co-workers,9 in which hyphae
and sclerotic bodies produced by H. pedrosoi
were found in the skin and brain lesions.
In none of the reported cases of brain
abscesses was the portal of entry of the
fungus definitely established, but it is
possible that the abscesses could have
resulted from vascular dissemination from
subcutaneous abscesses such as are described in our cases. Duque 8 lias demonstrated that Swiss albino mice injected
intraperitoneally with C. trichoides develop
both cerebral and peritoneal lesions containing the organisms. Thus it seems that,
at least experimentally, C. trichoides can be
disseminated to the central nervous system
from distant sites of infection.
In all 7 of the patients, the subcutaneous
lesions were single, discrete, asymptomatic,
and well encapsulated. They were excised
because the patient complained of a
localized cystic mass that the surgeon
diagnosed as ganglion, epidermal inclusion
cyst or foreign body abscess.* Simple
excision was curative, and in tire relatively
short follow-up period there have been no
local recurrences and no evidence of fungal
disease at other sites. All of the lesions were
on the hand or forearm except 1, which was
on the ankle. This finding is in contrast to
the high percentage of cases of cutaneous
chromoblastomycosis present on the lower
extremities.
Other authors have postulated that
cutaneous chromoblastomycosis results from
contamination of superficial wounds by
fungus present in vegetable matter and that
persons engaged in farming are most likely
to come in contact with such material.4
Four of our 7 patients lived in rural areas
and were engaged in agricultural work.
Inasmuch as lesions in these 7 cases were
* An additional subcutaneous lesion recently
encountered had been clinically diagnosed as a
Baker's cyst of the knee. It occurred in a 42-yearold woman and was histologically similar to the
lesions in the other 7 cases. (W.H.S.)
June 1963
ABSCESSES CAUSED BY P I G M E N T E D
subcutaneous and did not involve the skin,
however, it is probable that the infective
organisms were introduced by puncture
wounds rather than by contact of contaminated objects with superficial abrasions
of the skin. Patient 4, who was employed in
cleaning shrimp, an occupation in which the
hands are wet and sharp shells often puncture the skin, could understandably have
been so infected. In Case 3, a vegetable
fiber was present in the abscess. Some
investigators have reported successful artificial infections in laboratory animals by
injecting fungi of the Hormodendrum species
subcutaneously, intraperitoneally, or intracerebrally. 8,14 These animals develop subcutaneous or internal infections, depending
on the route of innoculation. In the subcutaneous and internal infections, the
lesions in all organs were histologically
similar to those occurring in the skin.
This experimental work supports the possibility that the lesions we are reporting
resulted from direct traumatic introduction
of contaminated material into the subcutaneous tissue.
One of the most striking findings in this
series was the fact that 4 of the 7 patients
had some serious systemic disease unrelated
to the fungal infection. Three had diabetes
mellitus, which was complicated in 1 by
congestive heart failure and in another by
multiple cerebral vascular accidents. A
fourth patient had chronic renal disease and
congestive heart failure. Although this
series is too small for definitive conclusions,
it seems that subcutaneous chromoblastomycosis infections may tend to occur in
patients with metabolic and debilitating
disease.
This report presents additional evidence
that the pigmented fungi may cause subcutaneous lesions as well as the better-known
cutaneous lesions, and therefore, all granulomatous inflammatory processes of the
subcutaneous tissue as well as those in the
skin should be examined carefully for these
organisms. The fungi are often so few
and so widely scattered in the lesion that
they may be difficult to find in hematoxylin
and eosin sections; however, they can be
FUNGI
605
readily demonstrated by means of applying
the PAS or Gridley technics, which stain
the organisms brilliantly. Although there
was no evidence of systemic dissemination
of the fungi from the local lesion in any of
our cases, this possibility must be recognized
as a potential hazard in lesions of this type
and location.
SUMMARY
1. Seven cases of subcutaneous abscess
containing brown pigmented fungi histologically similar to the Hormodendrum
species have been described. The abscesses
were single, small, asymptomatic lesions
diagnosed clinically as sebaceous cysts,
ganglion, or foreign body granulomas. None
were associated with cutaneous chromoblastomycosis. The lesions were located on
the hands, wrists, and ankle. Four of the 6
patients had apparently unrelated, nonfungal systemic disease. No similar cases,
with one possible exception, have been found
in the literature.
2. In all instances the lesions were controlled by simple excision.
3. Histologically, the inflammatory reaction within the subcutaneous tissue is
similar to that seen in cutaneous chromoblastomycosis. The causative fungi may be
found within the necrotic debris, free
among the fibroblasts and epithelioid cells,
or within the cytoplasm of giant cells. They
appear as brown pigmented, rounded, thickwalled, often septate, sclerotic bodies and as
brown pigmented, beadlike hyphal chains.
Both of these forms were present in all of
the cases and thus resemble the tissue phase
of Cladosporhtm trichoides, a species frequently isolated from brain abscesses
caused by pigmented fungi. The hyphal
forms are not usually found in tissue in
cutaneous chromoblastomycosis. The possibility that the pigmented fungi could be
disseminated from subcutaneous abscesses to
distant sites must be considered.
4. All subcutaneous abscesses with macrophage and giant cell response should be
examined for these pigmented fungi, which
are often difficult to find in hematoxylin and
eosin preparations.
606
Vol. 39
KEMPSON AND STERNBERG
SUMMARIO IN INTERLINGUA
1. Es describite 7 casos de abscessos subcutanee, continente fungos a pigmentation
brun, histologicamente simile a species de
Hormodendrum. Le abscessos esseva solitari,
micre, e asymptomatic. Clinicamente le
lesiones esseva diagnosticate como cystes
sebacee, gangliones, o granulomas a corpore
alien. Nulle esseva associate con blastomycosis cutanee. Le lesiones esseva locate super
le manos, carpos, e cavilias. Quatro del sex
patientes habeva apparentemente nonconnexe morbos constitutional non-fungal.
Nulle simile casos, possibilemente con un sol
exception, esseva trovate in le litteratura.
2. In omne le casos le lesiones esseva maestrate per simple excision.
3. Histologicamente, le reaction infiammatori intra le tissu subcutanee es simile
a illo vidite in chromoblastomycosis cutanee.
Le fungo causative pote esser trovate in le
debris necrotic, libere inter le fibroblastos
e le cellulas epithelioide, o intra le cytoplasma de cellulas gigante. Illo se presenta
como un corpore sclerotic, frequentemente
septate, ronde, de spisse pariete, e de pigmentation brun. Etiam un forma de catenas
hyphal occurre in que le corpores ha le apparentia de perlas de pigmentation brun.
Ambe iste formas esseva presente in omne le
casos. Isto es simile al phase tissular de
Cladosporium trichoides, un specie frequentemente isolate ab abscessos cerebral que es
causate per pigmentate fungos. Le forme
hyphal es usualmente non trovate in le tissu
in chromoblastomycosis cutanee. Debe esser
considerate le possibilitate que le pigmentate
fungos es disseminate ab abscessos subcutanee ad sitos distante.
4. Omne abscessos subcutanee con responsa de macrophagos e cellulas gigante
debe esser examinate pro le presentia de iste
pigmentate fungos le quales es frequentemente difficile a trovar in preparatos a
hematoxylina e eosina.
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