Funding information:
No funding was used for this Manuscript
Authors:
Dr. Wael Aljehani, Dermatology Specialist in Aachen University Hospital
(waljehani@ukaachen.de)
, Prof. Thomas Mentzel: Consultant of Pathology in Friderichafen
histopathology (dermpath@dermpath.de), Prof. Mosaad Megahed: Head of
Dermatohistopathology and Policlinic in Aachen University Hospital
(mmegahed@ukaachen.de),
Prof. Amir Yazdi: Head of Dermatology Department in Aachen University
Hospital
(ayazdi@ukaachen.de).
History:
A 62-year-old woman presented to our outpatient department with multiple
asymptomatic skin lesions on both medial thighs. The lesions developed
12 months ago and were slowly growing. There were no relevant underlying
illnesses or any current general symptoms, no regular intake of
medication.
Skin findings:
In the medial area of both thighs multiple, about 0.2 cm diameter,
annular configured, reddish small nodules with a relatively flat
surface.
Histology:
The entire dermis showed an increase in small vessels, surrounded by a
mild perivascular infiltrate. Additionally, often multinucleated giant
cells were observed.
Diagnosis:
Angiohistiocytoma with multinucleated giant cells
Therapy and Prognosis:
The diagnostic and treatment options of this benign condition were
explained to the patient. These options included surgical excision,
cryotherapy or laser therapy. Currently, she decided to follow a
watch-and-wait strategy.
Comment:
Angiohistiocytoma with polynuclear giant cells is a rare benign mixed
skin tumor, predominantly found in middle-aged women (F: M = 3: 1; [2,
6]). Predilection sites are distal extremities, in particular the
dorsal back of the hand or the medial parts of wrists and legs. They can
be solitary or multiple with a tendency to confluence, even individual
cases with disseminated or generalized appearance were described
[2]. Due to the clinical heterogeneity, there are numerous
differential diagnoses such as granuloma annular, Kaposi’s sarcoma,
sarcoid, multiple dermatofibromas and pseudo-Kaposi sarcoma [1, 2].
Also lichen planus should be in consideration if multiple small nodules
present [3]. The slowly growing tumor is in in most cases
asymptomatic [5, 6], but may be associated with slight itching [3,
4]. Histologically angiohistiocytoma with polynuclear giant cells is
classified as a benign mixed tumor; a malignant variant or
transformation has not yet been described [4]. The pathogenesis is
currently cryptic. Some authors claim that an interaction between mast
cells and factor XIIIa-positive fibrohistiocytic cells might cause
various proangiogenic cytokines to be released and thus ensures vascular
proliferation [5]. On the other hand, a reactive inflammatory event
after trauma might cause the influx of immune cells, as the disease
occurs more frequently in mechanically stressed regions such as the back
of the hand and the knees [7]. before
Acknowledgment:
We thanks the laboratory personnel at Friderichafen histopathology for
preparation of high quality histology slides.
Conflicts of interest:
The authors declare that there is no conflict of interest.
Ethics statement:
This case describes a rare condition
Written Consent from the patient:
Written informed consent was obtained from the patient for the
publication of this clinical image.
Detailed author’s contribution:
W. A.: Following the Patient and wrote the manuscript
M. T., Y.A., M.M.: made the histological and clinical diagnosis
Data availability Statement:
data sharing is not applicable to this article as no new data were
created or analyzed in this study.
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