Transepithelial Elimination of Cutaneous Chromomycosis

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Abstract
We have recently reviewed the histologic findings in two cases of cutaneous chromomycosis. Multiple histologic sections of surgical biopsy material disclosed changes that represent the phenomenon of transepithelial elimination (TEE). We suggest that TEE represents the histogenesis of the epithelial changes in chromomycosis and possibly other infectious granulomas. Materials and Methods Excisional biopsy specimens from active lesions of two patients with cutaneous chromomycosis were fixed in formaldehyde solution and stained with hematoxylin-eosin. A total of 460 sections were evaluated for the presence of fungal organisms and their relation to various stages of epidermal proliferation. Histologic Evaluation and Interpretation The epidermis showed parakeratosis and irregular acanthosis, with projections of the epidermal and follicular epithelium downward into the corium (Figure, top left). The dermis contained a dense inflammatory infiltrate composed predominantly of mononuclear cells (histiocytes, lymphocytes, a few plasma cells) and some foreign body giant cells intermingled with polymorphonuclear leukocytes. The organisms

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