Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
Letter to the Editor
2013:79:2;251-252
doi: 10.4103/0378-6323.107654

Multiple cutaneous reticulohistiocytomas along the lines of Blaschko associated with lichen striatus

Bruno Simo dos Santos, Enoi Aparecida Guedes Vilar, Paula Martins Freitas, Sandra Maria Barbosa Dures, Elisa Estrella
 Dermatology and Pathology, Antonio Pedro University Hospital-Federal Fluminense University, Rio de Janeiro, Brazil

Correspondence Address:
Bruno Simo dos Santos
Rua Marques de Paran 303, Niteri - Rio de Janeiro
Brazil
How to cite this article:
dos Santos BS, Guedes Vilar EA, Freitas PM, Barbosa Dures SM, Estrella E. Multiple cutaneous reticulohistiocytomas along the lines of Blaschko associated with lichen striatus. Indian J Dermatol Venereol Leprol 2013;79:251-252
Copyright: (C)2013 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Reticulohistiocytosis belongs to the group of non-Langerhans cell histiocytic disorders, which are characterized by the accumulation of histiocytes that do not represent the phenotype of Langerhans cells.Reticulohistiocytosis is characterized by dermal histiocytic infiltration of large, eosinophilic histiocytes with a "glassy" cytoplasm,and represents a spectrum of rare clinical entities: the solitary cutaneous form; the diffuse-cutaneous type without systemic involvement; and multicentric reticulohistiocytosis. [1],[2] Here we describe the case of multiple cutaneous lesions of reticulohistiocytoma with a distinct clinical presentation.

A 15-year-old girl presented with asymptomatic lesions that had developed over a period of 5 months on her left upper limb. She had no remarkable personal or family history of diseases and no other related symptoms. During physical examination, multiple erythematous, hyperchromic, and firm nodules varying in size (10-15 mm) were observed on the posterior surface of her left forearm, dorsum of the hand, and thumb along the lines of Blaschko. Furthermore, in the same topography, we noticed small hypochromic, isolated, and grouped papules and hypochromic macules over the nodular lesions [Figure - 1] and [Figure - 2]. Routine laboratory investigations showed no abnormalities. Histopathological examination of three nodules with hypochromic lesions on the overlying skin was performed, and all lesions showed the same features. Hematoxylin-eosin staining showed psoriasiform acanthosis, mild exocytosis of lymphocytes, and isolated keratinocyte necrosis in the epidermis. Focal lymphocytic infiltrate and focal vacuolar degeneration of the basal cell layer were seen at the dermal-epidermal junction. In addition, a dense dermal infiltrate, predominantly composed of large histiocytes and multinucleated giant cells with granular, eosinophilic, and ground-glass cytoplasm, was also noted. These histiocytes were positive for periodic acid-Schiff (PAS)-diastase. No Touton giant cells were present. Interestingly, lymphocytic infiltration of glandular ducts and eccrine glands was also observed [Figure - 3]. Immunohistochemical analysis showed that the histiocytes were positive for CD68 and vimentin, but negative for CD1a, factor XIIIa, and S-100 protein. Based on these findings, the diagnosis of reticulohistiocytomas associated with lichen striatus was made. The lesions were clinically stable during the 2-year follow-up period.

Figure 1: (a) Nodular lesions located along the lines of Blaschko on the hand and forearm. (b) Erythematous nodules on the proximal nail fold, hand, and forearm. (c) Demarcated lesions highlighting the topography. (d) Hypochromic papules over the forearm nodular lesions
Figure 2: Nodules and hypochromic papules and macules in the same topography
Figure 3: (a) Psoriasiform acanthosis and focal lymphocytic infiltrate at the dermal-epidermal junction (H and E, ×100). (b) Diffuse infiltration of the dermis with large, eosinophilic histiocytes (H and E, ×100). (c) Lymphocytic infiltrate involving the eccrine gland (H and E, ×200). (d) Histiocytes with ground-glass cytoplasm positive for PAS-diastase (×400)

Lichen striatus is an uncommon dermatosis with a striking linear distribution. It is most frequent in children. [3] Typically, lichen striatus is characterized by the presence of erythematous, lichenoid papules that generally develop along the lines of Blaschko, although hypopigmented macules and/or papules may occur in dark-skinned people. [4] Some histopathological findings of lichen striatus include hyperkeratosis, necrotic keratinocytes in the epidermis, mild spongiosis with exocytosis of lymphocytes, and focal or lichenoid lymphocytic infiltrate at the dermal-epidermal junction. Perivascular lymphocytic infiltration may also occur, and there may be involvement of hair follicles and/or eccrine glands. [3] Lichenoid epidermal change and a disturbed basal cell layer were found in some cases of solitary reticulohistiocytoma. However, there is no mention of lymphocytic infiltration of eccrine glands in such cases. [2] Moreover, hypochromic papules and macules have not been reported as clinical manifestations of reticulohistiocytoma. [1],[2] Thus, based on the clinico-pathological correlation, we believe that hypochromic macules and papules observed in this case best correspond to lichen striatus lesions associated with reticulohistiocytoma, which manifested as nodular lesions. Coexistence of lichenoid and granulomatous dermatitis in the same lesion has been reported. A single case of lichen planus associated with multicentric reticulohistiocytosis has been described. [5] Nonetheless, to our knowledge, this is the first report of multiple reticulohistiocytomas showing a Blaschko-linear distribution. Moreover, the coexistence of reticulohistiocytoma and lichen striatus has never been described in the medical literature so far.

References
1.
Zak FG. Reticulohistiocytoma ('ganglioneuroma') of the skin. Br J Dermatol 1950;62:351-5.
[Google Scholar]
2.
Caputo R, Marzano AV, Gianotti R. Asymptomatic nodule on the upper lip. Arch Dermatol 2003;139:381-6.
[Google Scholar]
3.
Zhang Y, McNutt NS. Lichen striatus: histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol 2001;28:65-71.
[Google Scholar]
4.
Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol 2004;21:197-204.
[Google Scholar]
5.
Magro CM, Crowson AN. Lichenoid and granulomatous dermatitis. Int J Dermatol 2000;39:126-33.
[Google Scholar]
Show Sections