# A Spindle Cell Tumor in Disguise: Histoid Nodules Arising From Peripheral Nerves

## TL;DR

A young man with unusual skin nodules was diagnosed with a rare form of leprosy affecting peripheral nerves.

## Contribution

This case report highlights a rare presentation of histoid leprosy involving peripheral nerves.

## Key findings

- Spindle-shaped histiocytes and acid-fast bacilli were identified in the nodules.
- Ultrasonography confirmed a rare form of neural histoid leprosy.
- The nodules were linked to thickened superficial cutaneous nerves.

## Abstract

A 25-year-old male presented with multiple, painless subcutaneous nodules, each measuring 5-6 mm, attached to thickened superficial cutaneous nerves. He also had nodular infiltration of the left earlobe. Histopathology revealed spindle-shaped histiocytes in a storiform pattern, with numerous acid-fast bacilli in Fite-Faraco staining. Skin slit smear from the nodule revealed a bacteriological index of +6. Ultrasonography of the nodule revealed a well-defined, avascular, heterogenous hypoechoic lesion over a focally thickened nerve with loss of fibrillary pattern, confirming a rare form of neural histoid leprosy.