muramidase and Histiocytosis

Five cases of pronounced histiocytic reaction in pelvic lymph nodes after hip replacement are demonstrated. Two patients subsequently underwent radical prostatectomies with bilateral lymph node dissections for adenocarcinoma. In three patients, the change was found during autopsy. The sinuses and interfollicular spaces were distended by numerous large macrophages that had bulky eosinophilic cytoplasm. The cells displayed immunoreactivity to KP1 antigen, alpha-1-antitrypsin and lysozyme, providing support for their histiocytic derivation. Polarization microscopy revealed birefringent needle-like particles in their cytoplasm. We think that the histologic appearance of lymph nodes represents a foreign body reaction to fragments of polyester or polyethylene derived from joint prostheses. It is necessary to be aware of this characteristic foreign body reaction in order to avoid confusion with other types of lymph node histiocytosis or with a metastatic tumor.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; alpha 1-Antitrypsin; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Arthroplasty, Replacement, Hip; Biomarkers; Birefringence; Diagnosis, Differential; Female; Histiocytosis; Humans; Immunohistochemistry; Lymph Nodes; Male; Microscopy, Polarization; Muramidase; Polyesters; Polyethylenes; Prostatic Neoplasms

Whereas Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is well described in lymph nodes and other organs, it is frequently not recognized in soft tissue. We studied the clinical and histologic features of 23 previously unreported soft tissue lesions from 17 patients (13 females, 4 males) who were 24 to 66 years of age (mean, 46 years). These lesions involved the extremities (12, 52%), trunk (6, 26%), head and neck (3, 13%), and the retroperitoneum (2, 9%). Associated lymph node involvement was present in four cases; most patients were asymptomatic. RDD of soft tissue had more subtle histologic features than its lymph node counterpart. Emperipolesis was less conspicuous and proliferating histiocytes were frequently spindled, associated with collagen deposition, and arranged in a vague storiform pattern with scattered lymphoplasmacytic aggregates. These features led to a variety of diagnoses, including benign inflammatory and fibrohistiocytic lesions (13 cases) as well as lymphoma and malignant fibrous histiocytoma (three cases). RDD was correctly diagnosed in only one case. Diagnosis was confirmed in 16 of 18 lesions by detection of S-100 protein and histiocytic markers KP1 (12 of 13) and lysozyme (eight of 11) in the characteristic histiocytes. Recognition that RDD of soft tissue occurs in an older patient population than does nodal RDD and that it mimics fibrous and inflammatory lesions of soft tissue is important.

Topics: Adipose Tissue; Adult; Aged; Connective Tissue; Connective Tissue Diseases; Female; Histiocytosis; Histiocytosis, Sinus; Humans; Immunohistochemistry; Lymphatic Diseases; Male; Middle Aged; Muramidase; S100 Proteins