Splendore-Hoeppli phenomenon on fine needle aspiration cytology of subcutaneous inflammatory lesions.

Objective: To put forth the importance of Splendore-Hoeppli (SH) material on fine needle aspiration cytology (FNAC) smears from subcutaneous inflammatory lesions.

Study design: This is a retrospective study that analyzes 33 cases of subcutaneous inflammatory lesions, diagnosed on FNAC over a 2.5-year period (January 2011-July 2013). Giemsa- and Papanicolaou (Pap)-stained smears were retrieved and reviewed.

Results: The cytological counterpart of SH material can be seen as acellular, dense, nonfibrillary homogenous bodies of varying sizes and shapes, purple to blue on Giemsa-stained and greenish on Pap-stained smears, respectively. Of the 33 cases, 15 showed the presence of SH material on the smears; 11/15 cases with SH material were positive for fungus. Of the 18/33 cases that were negative for SH material, there were 7 acid-fast bacilli-positive tuberculous lesions, 8 nonspecific inflammatory lesions, and 3 fungal infections. None of the cases showed actinomycete filaments or clumps of bacterial colonies. Histopathology was available in 4 cases.

Conclusion: SH material should be recognized on cytology smears as it is an indicator of a specific etiology and also helps rule out nonspecific inflammatory and tuberculous lesions.