S13C4aP2aAtypicalHistiocytosis



S13C4aP2a-1: An infiltrate of atypical cells is present in both the epidermis and the dermis. The pattern in the epidermis is likely to evoke a parcel of virtual images relevant to the interpretation of melanocytic dysplasias and early melanomas. On an earlier biopsy, the patterns had been interpreted as atypical histiocytosis X.

S13C4aP2a-2: At a higher magnfication, the cells of the nests are not closely attached to their neighbors. They have pale acidophilic cytoplasm and eccentric nuclei. Some of the cells individually infiltrate the epidermis. On the basis of the patterns in this field, both a pagetoid, intraepithelial carcinoma and pagetoid reticulosis might also be considered in the differential diagnosis.

S13C4aP2a-3: In this area, the epidermal patterns are less impressive; there are loose infiltrates of atypical mononuclear cells in a widened papillary dermis. Beneath the loose infiltrate of atypical cells, there is a band-like infiltrate of lymphocytes and histiocytes.

S13C4aP2a-4: In the epidermis, the nests of atypical cells are mostly above the basal layer. A compressed basal layer outlines this large nest; many of the compressed basal cells are pigmented (melanin pigmentation of basal keratinocytes). The atypical cells have pale, somewhat vacuolated cytoplasm. Their nuclei are eccentric and are irregular in outline; some are hyperlobated (a peculiar lymphoid lesion also should be considered in the differential diagnosis).

S13C4aP2a-5: In this field, cellular atypia is more pronounced, but some of the variations are apparently representative of the effects of technical problems. Nuclei vary in size and outlines. The cleft at the top of the field is in the epidermal domain; it is outlined along the floor of the cleft by a basement membrane. In the papillary dermis, the cells are loosely aggregated; they are not arranged in true nested patterns.

S13C4aP2a-6: The lesion recurred in a regional (axillary) lymph node. This field is representative of the patterns in the lymph node. The cytologic features are similar to those of the cutaneous lesion. One cell at the extremity of the green arrow has a deeply notched nucleus; these nuclear characteristics are of a type seen in lesions of histiocytosis X. Eosinophils are clustered to the right.

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