LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 2346
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 1  |  Page : 126
Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall


1 Department of Pathology, Maulana Azad Medical College, New Delhi, India
2 Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya (affiliated to Maulana Azad Medical College), Delhi, India

Click here for correspondence address and email

Date of Web Publication11-Apr-2012
 

How to cite this article:
Rao S, Khurana N, Mohta A. Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall. Indian J Pathol Microbiol 2012;55:126

How to cite this URL:
Rao S, Khurana N, Mohta A. Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Sep 26];55:126. Available from: http://www.ijpmonline.org/text.asp?2012/55/1/126/94888


Sir,

Nodular histiocytic proliferation/hyperplasia (NHP/NHH) is an uncommon reactive histiocytic proliferative lesion. NHP has mostly been described in mesothelium-lined locations and only in few non-mesothelial sites. The lesion can be confused with a variety of reactive, inflammatory, or neoplastic conditions.

We describe the pathologic features of a case of NHP in the (inguinal) hernial sac in a 2-year-old boy. The lesion revealed nodular aggregates of histiocytes scattered within the fibrocollagenous wall of hernial sac [Figure 1]a. The constituent cells showed moderate amount of eosinophilic cytoplasm, ovoid to slightly lobulated vesicular nuclei and inconspicuous nucleoli [Figure 1]b. Mitoses were infrequent, and there was no significant cellular atypia. Moderate degree of scattered inflammatory cells was also noted. There was no definite granulomas formation or areas of necrosis. Stain for acid fast bacilli was negative. Based on histomorphology, possibility of NHP and Langerhans' cell histiocytosis was considered. On immunohistochemical (IHC) staining, cells expressed CD68 [Figure 1]c and were negative for CD1a [Figure 1]d. Thus, a final diagnosis of NHP in hernial sac wall was made.
Figure 1: (a) Fibrocollagenous wall of hernial sac revealing nodular aggregates of histiocytic cells, (H and E, ×20). (b) Collection of mildly pleomorphic histiocytes, (H and E, ×60). (c) Cells expressing CD68, (IHC, ×20). (d) Cells show negative staining for CD1a, (IHC, ×20)

Click here to view


NHP is primarily an uncommon reactive histiocytic proliferative lesion which was previously referred to as Nodular Mesothelial Proliferation, but now, IHC has established the cell of origin to be histiocytic rather than mesothelial in nature. NHP has mostly been described in mesothelium-lined locations like peritoneal, pleural, and pericardial sites, [1],[2] and in few other non-mesothelial sites like endometrium and urinary bladder. [3],[4] In the literature, we have been able to find only one brief reference to this lesion presenting as a hernial nodule. [4] The lesion, however, has no therapeutic or prognostic significance and is often a chance finding as in the present case. The importance lies in the fact that the lesion can be confused with a variety of reactive, inflammatory, or neoplastic (like eosinophilic granuloma, granulosa cell tumor, chronic myeloid leukemia and carcinoma) conditions, as the histiocytes can show moderate atypia and high mitotic activity. [1],[3],[4] The purpose of this communication is to help familiarize pathologists with this lesion to prevent an erroneous diagnosis and unnecessary overtreatment.

 
   References Top

1.Chikkamuniyappa S, Herrick J, Jagirdar JS. Nodular histiocytic/mesothelial hyperplasia: A potential pitfall. Ann Diagn Pathol 2004;8:115-20.  Back to cited text no. 1
    
2.Ruffolo R, Suster S. Diffuse Histiocytic Proliferation Mimicking Mesothelial Hyperplasia in Endocervicosis of the Female Pelvic Peritoneum. Int J Surg Pathol 1993;1:101-6.  Back to cited text no. 2
    
3.Kim KR, Lee YH, Ro JY. Nodular Histiocytic Hyperplasia of the Endometrium. Int J Gynecol Pathol 2002;21:141-6.   Back to cited text no. 3
    
4.Ordóñez NG, Ro JY, Ayala AG. Lesions described as nodular mesothelial hyperplasia are primarily composed of histiocytes. Am J Surg Pathol 1998;22:285-92.  Back to cited text no. 4
    

Top
Correspondence Address:
Seema Rao
Department of Pathology, Maulana Azad Medical College, New Delhi - 110 002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.94888

Rights and Permissions


    Figures

  [Figure 1]

This article has been cited by
1 Signet ring cell mesothelioma; A diagnostic challenge
Hui Wang,Chaturika Herath
Pathology - Research and Practice. 2019; 215(7): 152462
[Pubmed] | [DOI]
2 Reactive histiocytic proliferation in the pleural fluid mimicking metastatic signet ring adenocarcinoma
Fatima Mir,Anam Naumaan,Hussein Alnajar,Arlen Brickman,Vijaya Reddy,Ji-Weon Park,Paolo Gattuso
Diagnostic Cytopathology. 2018; 46(6): 525
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2260    
    Printed46    
    Emailed0    
    PDF Downloaded66    
    Comments [Add]    
    Cited by others 2    

Recommend this journal