Department of Pathology,
University of Oklahoma Health Sciences Center
Answer: D (Langerhans' cell histiocytosis)
Level of difficulty:
- Pathology of the case: Two major populations of cells are
illustrated here. Many of them are eosinophils (Þ).
Many cells with small to medium amount of cytoplasm. The characteristic deeply
grooved "coffee bean" nuclei can be well appreciated at the
level of light (Þ)
These cells are the neoplastic Langerhans' cells. Langerhans' cells are
immunohistochemically reactive for CD1a and S100 protein. Ultrastructurally,
Birbeck granules are also seen. It should be noted that the amount of neoplastic Langerhans' cells may vary from abundant as in this case to scant.
The same token is true for the amount of eosinophils. Other inflammatory cells
and macrophages can also present. On cytologic preparation and also in
histologic sections, macrophages closely resemble the neoplastic Langerhans
cells. Macrophages, however, are negative for CD1a and S100. [Click
here to see a case]. Clinically, Langerhans'
histiocytosis often occurs in
the head and neck areas as osteolytic lesions. The larger ones may extend into
the soft tissue.
- Meningioma: Although meningiomas at the cranial
base may invade the surrounding bone and through the bone into the surrounding
soft tissue, they are not typically associated with a substantial amount of
eosinophils and their nuclei are not grooved. Meningioma cells in cytologic
preparations tend to stay in clusters with an epithelioid appearance.
Pseudonuclear inclusion are also common. Meningioma cells, however, can also
have nuclear groove.
- Acute infection with abscess:
The polymorphonuclear leukocytes here are almost exclusively eosinophils.
Neutrophils are almost always present in acute infection and abscess
formation. Necrotic debris should also be seen. On the other hand, the "coffee
bean" cells should not be representing a significant proportion of the cells
in abscess formation.
- Hodgkin's lymphoma: The Reed-Sternberg cells are
far more pleomorphic than the neoplastic Langerhans' cells. A pure background
of eosinphils rather than a background of mixed inflammatory cells is rather
unusual for Hodgkin's lymphoma.
- Myeloid sarcoma: The myeloid sarcoma cells are
also far more pleomorphic than the Langerhans' cells.
here to see a similar case]