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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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ENIGMATIC MORPHO INSIGHT  
Year : 2018  |  Volume : 22  |  Issue : 2  |  Page : 161-162
 

Splendore–Hoeppli phenomenon


Department of Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, HK, China

Date of Web Publication2-Aug-2018

Correspondence Address:
Divya Gopinath
Department of Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, HK
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_79_18

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How to cite this article:
Gopinath D. Splendore–Hoeppli phenomenon. J Oral Maxillofac Pathol 2018;22:161-2

How to cite this URL:
Gopinath D. Splendore–Hoeppli phenomenon. J Oral Maxillofac Pathol [serial online] 2018 [cited 2018 Oct 23];22:161-2. Available from: http://www.jomfp.in/text.asp?2018/22/2/161/238298




Splendore–Hoeppli phenomenon (asteroid bodies) is characterized by microorganisms (fungi, bacteria and parasites) or biologically inert substances surrounded by radiating intensely eosinophilic material. This morphologically unique reaction was first described in sporotrichosis by Splendore and in schistosomiasis by Hoeppli.[1] The eosinophilic material seen in Splendore–Hoeppli reaction has been described to be due to deposition of antigen–antibody complexes and debris from the host inflammatory cells.[2],[3] Microscopically, Splendore–Hoeppli reaction appears as strongly eosinophilic amorphous material with radiating star-like or club-shaped-like configurations [Figure 1] surrounding or adjacent to the causative agent.[3],[4]
Figure 1: Histological features of Splendore–Hoeppli phenomenon appearing as strongly eosinophilic amorphous material with star-like (asteroid) configuration

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It is often accompanied by inflammatory reaction rich in eosinophils, histiocytes, epithelioid cells and giant cells [Figure 2]. Occasionally, this reaction is seen in the midst of wide areas of degeneration and necrosis. In fungal infections, the reaction is demonstrated as eosinophilic cuff surrounding the hyphae [Figure 3] with a radius of up to 20 mm.[5] Sometimes, it is even seen without any association to identifiable causative agent. In such cases, the reaction illustrates as granulomas with a necrotic eosinophilic center surrounded by a ring of epithelioid cells and giant cells.[3],[6]
Figure 2: Splendore–Hoeppli phenomenon amid granulomatous reaction composed of histiocytes and inflammatory cells and occasional giant cells

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Figure 3: Hand-drawn illustration of the mechanism of Splendore–Hoeppli phenomenon representing fungal hyphae surrounded deposition of antigen–antibody complexes, glycoprotein and debris from host inflammatory cells

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The fungal infections which often demonstrate this phenomenon include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. It is also seen in bacterial infections such as botryomycosis, nocardiosis and actinomycosis, and parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, noninfective pathologies such as hypereosinophilic syndrome and allergic conjunctival granulomas have been shown to demonstrate this phenomenon occasionally.

The exact nature of the Splendore–Hoeppli reaction is not completely known. However, it has been thought to represent deposition of antigen–antibody complexes and debris from host inflammatory cells.[3] Alternatively, they may represent glycoproteins, lipid and calcium derived from host leukocytes.[7] Further studies exploring the mechanism of this phenomenon are needed for the detailed portrayal of this reaction.

Differential diagnosis includes flame figures in Well's syndrome, actinomycotic sulfur granules, asteroid bodies in sarcoidosis, tophaceous lesions of gout, perivascular fibrin deposition and keratin granuloma.[3] Flame figures are degranulated eosinophils that form aggregates of granular material which are surrounded by collagen and can also be seen in insect bites and drug eruption.[7],[8] The central branching filaments or diphtheroid forms are not visible in Splendore–Hoeppli reaction and hence this absence assist to make a distinction from true actinomycotic sulfur granules.[3] Asteroid bodies are eosinophilic stellate inclusions which are usually seen within the giant cells present in sarcoid granulomas and rarely in other granulomas.[3] Gout granules appear as deposits of amorphous material of varied sizes with parallel clefts and often these crystals have a brownish hue and are double refractile in polarized light.[3]

Prompt identification of this reaction can play a significant role in understanding the underlying pathology when the histological presentation is not classic and overlapping conditions can otherwise hinder the diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kwangsukstith C, Vanittanakom N, Khanjanasthiti P, Uthammachai C. Cutaneous sporotrichosis in Thailand:First reported case. Mycoses 1990;33:513-7.  Back to cited text no. 1
    
2.
Liber AF, Choi HS. Splendore-Hoeppli phenomenon about silk sutures in tissue. Arch Pathol 1973;95:217-20.  Back to cited text no. 2
    
3.
Hussein MR. Mucocutaneous Splendore-Hoeppli phenomenon. J Cutan Pathol 2008;35:979-88.  Back to cited text no. 3
    
4.
Smith JH, Von Lichtenberg F. The Hoeppli phenomenon in schistosomiasis. II. Histochemistry. Am J Pathol 1967;50:993-1007.  Back to cited text no. 4
    
5.
Miller RI, Campbell RS. The comparative pathology of equine cutaneous phycomycosis. Vet Pathol 1984;21:325-32.  Back to cited text no. 5
    
6.
Orhan D, Kiratli H, Kocabeyoǧlu S. Conjunctival Splendore-Hoeppli phenomenon in a 3-year-old child. Pediatr Dev Pathol 2006;9:388-90.  Back to cited text no. 6
    
7.
Bhagavan BS, Ruffier J, Shinn B. Pseudoactinomycotic radiate granules in the lower female genital tract: Relationship to the Splendore-Hoeppli phenomenon. Hum Pathol 1982;13:898-904.  Back to cited text no. 7
    
8.
Clinicopathologic conference: Systemic blastomycosis involving genitourinary tract and skin. J Tenn Med Assoc 1973;66:1141-2.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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