The biopsy specimen revealed slight irregular epidermal acanthosis and focal parakeratotic scale. In the superficial and deep dermis, there were numerous granulomas. The center of the granulomas were focally necrotic, admixed with polymorphonuclear leukocytes, and surrounded by histiocytes, lymphocytes, plasma cells, multinucleated giant cells, and a few eosinophils. Periodic acid–Schiff and Gomori methenamine-silver stains confirmed the presence of fungal spherules within the giant cells. A few spherules were seen free within the dermis. The spherules ranged from 5 to 20 µm in diameter. No budding was evident, and no hyphal elements were observed.
Nonhealing Neck Ulcers. Arch Dermatol. 1998;134(3):365-370. doi: