Histiocytes and histiocytic reaction in vaginal cytology. A survey of the risks of false positive diagnosis.
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We describe a primary splenic neoplasm composed of cytomorphologically malignant-appearing erythrophagocytic histiocytoid cells reminiscent of those seen in malignant histiocytosis. However, this neoplasm displayed certain distinctive clinicopathologic features--including localization to the spleen, where it grew as separate discrete nodules--that distinguish it from all previously reported cases of malignant histiocytosis. The cells expressed a monocyte/histiocyte immunophenotype and lacked clonal immunoglobulin and T-cell receptor beta-chain gene rearrangements. Our results suggest that this neoplasm represents a clinicopathologically distinctive and possibly unique tumor derived from the tissue macrophage lineage.
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The metalophil method for the demonstration of histiocytes was applied to 108 non-Hodgkin lymphomas diagnosed according to the Kiel classification. In 41 lymphomas the presence of histiocytes was assessed with the aid of the non-specific esterase reaction. The same procedures were performed on 12 lymph nodes with follicular hyperplasia and/or sinus histiocytosis. The number of histiocytes was estimated and graded from 0 to 3. A good correlation between the two methods was found. Dendritic histiocytes were typically absent in lymphocytic lymphomas (CLL type). The follicles were clearly delineated by the distribution of dendritic histiocytes in follicular centroblastic/centrocytic lymphomas. In diffuse centrocytic lymphomas a small to moderate number of slender dendritic histiocytes was seen (grades 1-2). In lymphoplasmacytic/lymphoplasmacytoid lymphomas and in diffuse centroblastic/centrocytic malignant lymphoma the majority showed a great number of pleomorphic dendritic histiocytes (grade 3). In high-grade malignant lymphomas (centroblastic, immunoblastic and lymphoblastic categories) either a high to moderate number of pleomorphic dendritic histiocytes was found or they were totally absent. The lack of histiocytes in centroblastic lymphomas was especially noteworthy. It is proposed that dendritic histiocytes proliferate or are attracted in malignant lymphomas by the presence of centrocytes, especially in combination with centroblasts and by the presence of plasmacytoid cells or their precursors. The frequent absence of dendritic histiocytes in high-grade malignant lymphomas may alternatively be explained by the loss of physiological properties in less differentiated cells.
We studied the morphologic, antigenic, and enzymatic characteristics of the histiocytes in an isolated extranodal case of sinus histiocytosis with massive lymphadenopathy (SHML) involving the CNS. To our knowledge, this represents the first immunohistochemically documented case of CNS SHML. The histiocytes exhibited the S-100(+), CD11c(+), alpha-1-antichymotrypsin(+) immunophenotype, which suggests that the histiocytes of SHML coexpress phenotypic characteristics of histiocytes of the mononuclear phagocytic system, and histiocytes of the interdigitating reticulum cell and Langerhan cell lineages. To examine the argument that the histiocytes in SHML may represent ordinary tissue macrophages of granulomatous inflammation, we compared the immunophenotypic characteristics of the histiocytes found in SHML to those found in xanthogranulomatous pyelonephritis (XP). We found that the histiocytes of XP have immunophenotypic characteristics of histiocytes belonging to the mononuclear phagocytic system lineage. The present study demonstrates that the histiocytes of SHML are distinct from the histiocytes of another xanthogranulomatous disorder, supporting the concept that SHML is a distinct clinicopathologic entity.
OBJECTIVE: To evaluate the significance of histiocytes on normal cervical smears from postmenopausal women and correlate them with endometrial pathology. STUDY DESIGN: Histiocytes were classified into three types. The clinical history was obtained from cytologic and surgical reports. RESULTS: Among 108 cervical smears, 13 had large, foamy histiocytes (type A), 88 had histiocytes resembling superficial endometrial stromal cells (type B), and 7 had variably sized histiocytes alone or in association with inflammatory or multinucleated cells (type C). Endometrial pathology was identified in 13 patients (12.0%): 4/13 with type A histiocytes (2 endometrial adenocarcinomas, 2 endometrial polyps), 8/88 with type B histiocytes (8 endometrial polyps) and 1/7 with type C histiocytes (endometrial polyp). Among 70 patients with no clinical indications for endometrial sampling except for the presence of histiocytes, 4 demonstrated endometrial pathology (all endometrial polyps). In contrast, endometrial pathology was identified in 9/38 with clinical indications for endometrial sampling. Among the 13 patients with endometrial pathology, 9 had a significant clinical history (sensitivity of 69.2%), and 4 had histiocytes as the only indication for endometrial biopsy (sensitivity of 30.8%). CONCLUSION: A significant clinical history is more predictive of endometrial pathology and outweighs the significance of histiocytes as an indication for endometrial biopsy.
BACKGROUND: Tumor cells of malignant melanoma, the "great imitator," may morphologically mimic almost any cell, including histiocytes. Immunohistochemical stains for histiocytes are often used to distinguish histiocytic lesions that resemble melanomas, but we have noted and others have reported that these markers may be immunoreactive in melanomas. METHODS: We evaluated 43 primary and metastatic melanomas with traditional markers for melanomas (S100, HMB45, and NKI-C3) and common markers used for histiocytes (alpha-1-antitrypsin or AAT, CD68/KP1, HAM56, Mac387, and Muramidase). The extent (<5%, 5 to 30%, 30 to 60%, 60 to 90%, >90%) and intensity (1+ to 4+) of staining were recorded semi-quantitatively. RESULTS: Melanoma immunoreactivity (>5% of tumor cells) was as follows: S100, 100%; HMB45, 91%; NKI, 91%; AAT, 95%; CD68, 86%; HAM56, 26%; Mac387, 7%; and Muramidase, 30%. Among the histiocytic markers, staining by AAT and CD68 was typically diffuse but weak. Staining by HAM56, Mac387, and Muramidase was usually focal. In contrast, the traditional melanoma markers showed diffuse and strong staining. Interpretation of the histiocytic markers was complicated by scattered atypical histiocytes and pigmented tumor cells. CONCLUSION: Melanomas are commonly immunoreactive for histiocytic markers. AAT and CD68 immunostains are diffusely positive almost as frequently as traditional melanoma markers, although with weaker intensity. HAM56, Mac387, and Muramidase are less commonly positive and exhibit focal staining. Therefore, depending on the context, histiocytic markers may not be helpful in differentiating histiocytes and histiocytic tumors from melanomas.