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.
References:
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