Clinico-Histopathological Correlation in Leprosy

Abstract

Clinical diagnosis of early leprosy lesions poses difficulties. The present study was carried to correlate histological diagnosis of skin biopsies of untreated leprosy cases with clinical diagnosis using RidleyJopling classification. 270 skin biopsies of untreated leprosy cases over a period of two years were included . Paraffin sections of biopsies were stained with Hematoxylin & Eosin, Ziehl-Neelsen’s & Fite’s stains, examined and classified histopathologically according to Ridley- Jopling scale and then correlated with clinical diagnosis. Overall concordance of clinical and histopathological diagnosis was seen in 53.44% cases with maximum parity in lepromatous leprosy (75.86%), followed by borderline lepromatous (58.82%), borderline tuberculoid (53.01%), tuberculoid (47.37%), and least in mid-borderlin e cases (37.35%). Indeterminate leprosy cases showed 100% clinicopathological concordance. There was minor disagreement (difference of one group) in 29.56% and major disagreement (difference of two or more groups) in 17% cases. We noted minor disagreement in polar leprosy (TT+LL) and major discordance in borderline group (BT+BB+BL). Cases in borderline group are in continuously changing immunological spectrum and histological classification because of its definitve features gives a better indication than clinical classification for any recent shift of a case in the spectrum. Skin biopsy may be studied in all cases of leprosy for better diagnosis.