Malignant Histiocytic Tumors Of The Skin

The dermatopathologic aspects of malignant histiocytic tumors are even more perplexing because of the extreme scarcity of observations. No typical clinical pattern or course has been identified. In those cases where the histiocytic nature of a malignant neoplasm of the skin has been unequivocally proven, the malignant histiocytic tumors (histiocytic sarcomas) of the skin have occurred as single or multiple tumors and have been either confined to the skin (no extracutaneous involvement) or a part of multisystemic involvement (''malignant histiocytosis"). The prognosis in the latter case is poor. Histologically, these tumors demonstrate a proliferation of large, pleo-morphic, round to oval or polygonal cells with slightly eccentric nuclei, small distinct nucleoli, and abundant eosinophilic (H&E staining) or grayish (Giemsa staining) cytoplasm. Spindle cells, giant cells, and emperipolesis can be seen. The immunophenotype is decisive for the categorization of a neoplasm as histiocytic sarcoma and for its differential diagnosis from lymphomas and malignant tumors of accessory den-

Table 1 Immunohistochemistry in Differential Diagnosis of Malignant Histiocytic and Dendritic Cell Neoplasm

Neoplasm

CD68, LYS

CD1a, S-100

CD21 /CD35

Histiocytic sarcoma

CD68+, LYS+

CD1a—, S-100—/+

Langerhans cell

CD68+, LYS-/+

CD1a+, S-100+

tumor/sarcoma

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