Small Papules Secondary to a Dermal Process


Fig. 10.1 Lichen nitidus. A, Courtesy, Yale Dermatology Residents’ Slide Collection.







Histopathology:


Epidermal rete demarcating a lymphohistiocytic infiltrate in the superficial dermis




Histiocytoses


There are classic presentations of different histiocytoses (Fig. 10.2, Table 10.1), and the typical lesion is a dermal red–brown to pink papule for non-Langerhans cell histiocytoses. Such papules may also be seen in Langerhans cell histiocytosis (LCH), but the more common LCH lesion is an eroded and purpuric papule or plaque. In practice, there is significant overlap between various histiocytoses; the clinical distribution, other clinical lesions, and/or histopathologic features may be helpful in categorization.


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Fig. 10.2 Histiocytoses. A Typical distribution of different histocytoses. GEH, generalized eruptive histiocytosis; ICH, indeterminate cell histiocytosis. B Classic clinical lesion and cytologic features (“high magnification” view) of selected histiocytoses. Photographs courtesy, Irwin Braverman, MD; Ingo Haase, MD, and Iliana Tantcheva-Poor, MD; Jean L Bolognia, MD and Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.


Table 10.1


Classic features of selected histiocytoses




























Histiocytosis Classic clinical features Classic histopathologic features
Langerhans cell histiocytosis (Fig. 10.3A–C)

• Eroded, purpuric papules/plaques in intertriginous zones


• Ulcerations


• Pink to red–brown dermal-based papules without surface change

• Dermal Langerhans cells (Langerin+, CD1a+ [Fig. 10.3B,C], S-100+)


• Eosinophils may be present

Generalized eruptive histiocytoma (Fig. 10.3D,E)

• Favors the face and trunk


• Red–brown papules

• Dermal histiocytic infiltrate (CD68+), often without obvious giant cells

Indeterminate cell histiocytosis

• Favors the trunk and proximal extremities


• Red–brown papules

• Dermal histiocytic infiltrate (S-100+, CD68+, CD1a−, Langerin−)

Multicentric reticulohistiocytosis (Fig. 10.3F,G)

• Favors acral sites


• Pink to red–brown papules

• Two-toned giant cells

Rosai–Dorfman disease (Fig. 10.3H–K)

• Red–brown papules or plaque(s)/nodule(s)


• Massive, painless bilateral cervical lymphadenopathy is characteristic

• Emperipolesis


• S100+ multinucleate cells (Fig. 10.3J–K)


• CD68+

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Mar 5, 2017 | Posted by in Dermatology | Comments Off on Small Papules Secondary to a Dermal Process

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