Botryomycosis

BOTRYOMYCOSIS (from botrys—bunch and mykes—fungus), a name given by the Lyon dermatologists Poncet and Dor to a special form of benign tumors, sitting on a stalk of varying size, described by them in 1897. This disease was previously considered analogous to the botryomycosis of horses. Subsequently, however, the error of this was revealed, and other names were proposed: granuloma pediculatum benignum, granuloma pyogenicum, and granuloma teleangiectaticum. The etiology of this condition has not yet been definitively clarified. Many attach great importance to minor trauma, a prick, or a crack, which (Figure 1. Granuloma pediculatum of the head (low magnification)) serve as a portal of entry for the infection. Among the various theories, one must point to the mycotic one; however, it has not been confirmed by experimental data (the fungus could not be isolated); the amoebic and protozoan theories also proved untenable. The most generally accepted is the microbial theory. It is based on the constant finding in pus cultures of botryomycosis in humans of colonies of microbes closely related to Staphylococcus aureus; however, it is pointed out that these microbes are of secondary origin. Histologically, botryomycosis represents a tumor-like proliferation of granulation tissue, rich in dilated vessels with swollen endothelium (see Figure 1). These newly formed vessels are sometimes arranged in a specific order; sometimes they are surrounded by an infiltrate of a most diverse character. At the periphery, the tumor is surrounded by denser connective

(Fig. 2. Botryomycosis.) tissue. In some cases of botryomycosis, the microscopic picture bears a great resemblance to an angioma or angiosarcoma. The tumor has a firm-elastic consistency, a rounded shape, a size from a pea (see Figure 2) to a hazelnut, a dark red color, and a lobulated, as if incised, surface; the latter, at the beginning of the tumor's formation, is covered with intact but slightly thinned epithelium, which may thin out to the point of exposing the papillary layer, with subsequent bleeding. One of the characteristic features of the tumor is its attachment to the skin by means of a fibrous stalk of varying length. The tumor is painless and can be located on any part of the body, most often on exposed surfaces; it develops rapidly, but upon reaching a certain size, it can remain for an indefinitely long time without causing any trouble to the patient. The diagnosis is not difficult; in rare cases, only a distant resemblance to the papillary form of cancer, or to frambesiform and vegetating tubercular syphilid, may be observed; in doubtful cases, the question is resolved by biopsy. As therapy, surgical intervention is recommended, which always yields good results provided that the stalk of the tumor is radically removed, which is possible if healthy skin is also included during the operation. The tumor can also be radically removed by radiotherapy, cauterization, and by means of carbonic acid. Human botryomycosis is encountered quite frequently; thus, Lenormant counts 126 cases in the literature, and Perrin indicates that the average annual number of cases at the St. Louis Hospital is 4–5.

Z. Grzhebin.