Multiple cutaneous reticulohistiocytoma in middle aged female
A 35-year-old female presented with gradual onset of multiple skin colored, asymptomatic pea sized swellings, which started with face and gradually involved back, arms, and legs. There was no history of preceding local trauma, discharge, pain in these lesions. There were no constitutional symptoms like fever, joint pain, and complaints referable to other systems. The patient's main concern was regarding the cosmetic appearance as lesions were present over the face. Her family history was negative and she had no history of any other chronic illness.\nThe patient appeared in good general health with normal weight and height. Mucocutaneous examination revealed multiple (20 in number), discrete, skin colored nodules, 1–2 cm in size scattered over her face, back, abdomen, thighs, and lower legs []. They were firm in consistency, non tender with a smooth surface. Hair, nail, and mucosa were normal. Her systemic examination did not reveal any abnormality. Her complete blood count along with general blood picture, liver, and renal function tests, fasting lipid profile and urinalysis were normal. Abdominal and pelvis ultrasound were found to be normal. Radiographs of chest, knee, and bilateral hands were found to be normal. Rheumatoid factor and antinuclear antibodies were found to be within normal limits. On the basis of history and clinical examination, differential diagnosis of xanthoma, reticulohistiocytoma, sarcoidosis, and histoid leprosy were made.\nExcisional biopsy of a nodule over the trunk was done and histopathological examination revealed circumscribed large focus of diffuse dense infiltrate of large histiocytes and histiocytic giant cells with scattering of lymphocytes and a few neutrophils []. The histiocytes had rounded vesicular nuclei and abundant pink homogenous stained ground glass cytoplasm. Some of these also had foamy cytoplasm. Several histiocytic giant cells resembling the Touton giant cells were also seen []. Overlying epidermis showed flattening and thinning and was covered by parakeratosis containing collection of neutrophils. Based on clinical and histopathological findings a diagnosis of multiple cutaneous reticulohistocytoma was made. The nature of the disease was explained to the patient and was referred to the plastic surgeon for the cosmetic correction of the facial lesion. Patient was advised to review if any new lesions or any new complaints develop. Lesions remained stable with no significant disability even after 6 months of follow up.