S13C3P1-1: Histiocytosis X (Langerhans histiocytosis) clearly belongs in a borderline category. In lesions of this disorder, distinctive histiocytes, having eccentric nuclei, delicate chromatin, and pale cytoplasm form diffuse infiltrates. Many of the cells have deeply notched nuclei (“labia-like” [blue arrows]). Eosinophils often are a prominent component of the infiltrates (green arrows). The infiltrates usually are most prominent in the upper portion of the dermis with a preference for the papillary dermis; the epidermis may be involved.

S13C3P1-2: Characteristically, the infiltrates of histiocytosis X are diffuse with a variable admixture of eosinophils. The cells tend to be cytologically monotonous, as they are in this field.  For some examples, the degree of cytological atypia is variable and the cytological features are sufficiently deviant to qualify the patterns as atypical histiocytosis X. This qualification occasionally seems justified by a clinical course which is more aggressive than that of the usual examples. Atypia is not a significant feature of this field. Many of the cells have deeply notched or grooved nuclei.

S13C3P1-3: This field is representative of patterns in a lesion of bone. In this lesion, there is some degree of atypia with variations in nuclear size. Eosinophils, neutrophils, and lymphocytes are sprinkled among the histiocytes. Green arrows point to cells with deep nuclear grooves. The atypical histiocytes have an altered nuclear/cytoplasmic ratio (histiocytosis X).

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