Clinicopathological Analysis of Oral Paracoccidioidomycosis in Women.

Abstract

Paracoccidioidomycosis (PCM) is a deep systemic mycosis caused by Paracoccidioides brasiliensis. PCM affects predominantly men in their fifth and sixth decades of life, with low prevalence in women. The reasons for this discrepancy are not fully understood, but oestrogen may influence the transformation of the fungus and modulate the immune response.

Objective: To describe and correlate the clinical and histopathological characteristics of oral PCM in women.

Material and methods: This study analysed 45 cases of oral PCM in women, collecting clinical data such as age, smoking and alcohol consumption habits, pain, lesion location, duration of symptoms, presence of unique or multifocal lesions, as well as associated findings such as skin lesions, lymphadenopathy and systemic alterations. Additionally, histopathological characteristics were examined, including the presence of fungi, the quantity of multinucleated giant cells and the presence of well-organised granulomas, non-granulomatous areas, microabscesses and pseudoepitheliomatous hyperplasia. All data were recorded, tabulated and subjected to statistical analysis. Fungal quantification in the analysed slides was performed using the QuPath software, counting each fungal structure and analysing it based on the calculated specimen area.

Results: The average age of patients was 44.18 years (range: 20-68 years). Over half (53.3%) were smokers and 20% were alcoholics. Most lesions were multifocal (51%), with the alveolar ridge being the most commonly affected site, and pain was reported by 68.89% of the patients. Histopathologically, 33.33% of lesions had a low count of visible fungi per square millimetre, 37.78% had a moderate count and 28.89% had a high count. Most lesions (82.22%) contained many multinucleated giant cells, 55.56% had well-organised granulomas, 75.56% presented with microabscesses and 88.89% showed pseudoepitheliomatous hyperplasia.

Conclusion: Despite its rarity in women, PCM has similar clinical and histopathological features compared to those in men and should be considered in the differential diagnosis of unique and multifocal ulcerated lesions.