S13C6aP4aHistiocytosis



S13C6aP4a-1: This is an example of lymph nodal sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Distinctive histiocytes are clustered in the area to the left - the area which is outlined by green arrows. Green arrows also identify histiocytes that are loosely scattered. The histiocytes are plump and pale. With a reaction for the demonstration of S-100, the plump histiocytes are immunoreactive. The cells in the cluster probably are in a sinusoid.

S13C6aP4a-2: Distinctive, pale histiocytes of sinus histiocytosis are clustered in sinusoids. The compressed medullary cords contain infiltrates of lymphocytes with a high component of plasma cells. The plump, pale histiocytes have eccentric nuclei with open chromatin patterns. Inflammatory cells, including lymphocytes and neutrophils, are present in the cytoplasm of some of the histiocytes ( emperipoeisis). The changes are those of a “sinus histiocytosis”- the implication being that the distinctive cells are altered sinus histiocytes. Cutaneous lesions of this disorder show infiltrates of a similar cytologic character.


S13C6aP4a-3: Distinctive, pale histiocytes of sinus histiocytosis with massive lymphadenopathy contain inflammatory cells in their cytoplasm. Some of the endocytyzed cells are outline by a clear halo. The green arrow to the left points to a neutrophil (with a peripheral halo) in the cytoplasm of a histiocyte. Plasma cells are prominent in the adjacent inflammatory infiltrates.

S13C6aP4a-4: Some of the inflammatory cells in the cytoplasm of the histiocytes are outlined by clear haloes (green arrows).

S13C6aP4a-5: The histiocytes of multicentric reticulo-histiocytosis are represented in this field. The giant cells show a random distribution of nuclei. Some of the cells show zones of cytoplasmic basophilia near their periphery (red arrows). Perhaps, this cytoplasmic basophilia is what some observers have characterized as “ground-glass” cytoplasm. Certainly this is not the same “ground-glass” quality sometimes emphasized in the description of cellular changes in other diseases in other organ systems (i.e., the ground-glass cytoplasm of hepatocytes in viral hepatitis B). This is probably the type of change which prompted H. Montgomery to characterize a lesion, showing cells with similar cytoplasmic qualities, as a ganglioneuroma. Some of the histiocytes show peripheral cytoplasmic vacuoles (green arrows).

S13C6aP4a-6: Cells outlined by green arrows show cytoplasmic vacuoles. Condensations of basophilic material are present in the cytoplasm near the cell membrane level.

Cytoplasmic vacuoles and peripheral, cytoplasmic basophilic granularity are features of many of the cells. If this is the type of cell characterized as a ganglion cell by Montgomery, then he apparently mistook the basophilic granules for Nissl substance of ganglion cells.

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