Histology

The hallmarks of the disease are diffuse infiltrates of oncocytic histiocytes with ample eosinophilic, finely granular ("ground-glass") cytoplasm, and small round nuclei (Figs. 2 and 3). Along with these mononuclear histiocytes, large (50-100 pm) multinucleated cells (up to 20 nuclei) are observed. In addition, the infiltrate contains a few small lymphocytes, neutrophils, plasma cells, and eosinophils. The cytoplasm of the histiocytic cells is PAS-positive and diastase resistant. In addition, in most cases, the cells stain strongly with Sudan black B fat stain and oil red O. The infiltrate usually displays an interstitial pattern. An increase in reticular fibers (Gomori stain) can be seen. In older lesions, fibrosis may develop (9,10).

Figure 2 Multicentric reticulohistiocytosis: diffuse infiltrate of histiocytes throughout the entire dermis. (Specimen courtesy of W. Burgdorf, Germany.)

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