Wolbach and Schaumann type inclusions in the giant cells in leprosy probable value in prognosis.

Although the presence of giant cells in any type of lesion in leprosy is not a rarity, the presence of inclusions in their cytoplasm is infrequent. We do not refer to the fatty content in the category of inclusions, but to the bodies known as cytoplasmic inclusions of Wolbach (12) and those of Schaumann (10). Wolbach described and depicted, with photomicrographs and colored drawings, intracellular bodies of stellate appearance found in various organs in five cases of a series of 900 autopsies. Since the patients had died of diverse diseases, he concluded that those bodies were of a nonspecific nature, possibly derived from fibrin. Such bodies have been reported as found in leprosy tissues by several writers. Mallory (6), with whom Wolbach was long associated, published a picture of a "spiculated body" in a giant cell which also contained leprosy globi with many bacilli. At about the same time Lombardo (4) reported briefly the finding of such "asteroid" bodies, which he believed to be of the nature of elastin, in cutaneous lesions of two leprosy cases; and he mentioned previous reports of their observation in other diseases, including a case of Boeck's sarcoid (Winkler). In a more extensive study of these bodies (5) he presented several excellent photomicrographs. Mitsuda (9) described and sketched stellate bodies in giant cells of leprosy, noting that they stained by methods which demonstrate elastic tissue and by Bielschowsky's silver method. Soeur Marie-Suzanne and Policard (7), who found them in specimens of 4 out of 58 leprosy cases examined, regarded them as accumulations of waste substances in the cytoplasm of the giant cell. Most recently, Vilanova and Esteller (11) concluded that these bodies result from the digestion and incomplete lysis of endocapillary bacillary emboli, and that they evidence organic defense against the leprosy infection. With respect to sarcoid-according to Friedman (2), who suggested that the underlying condition in Wolbach's cases may