Multicentric reticulohistiocytosis: a cause of dysphagia with response to corticosteroids

Multicentric reticulohistiocytosis: a proliferation of macrophages with tropism for skin and joints, part II

In this second part of the review of multicentric reticulohistiocytosis, the authors discuss its association with other diseases, in particular, cancer, and laboratory and therapeutic aspects of this incapacitating and disfiguring disease. Histopathologic aspects are characteristic: dense mononuclear infiltrate with typical multinucleated cells that contain periodic acid-Schiff-positive and diastasis-resistant material, conferring a "ground glass" aspect when stained with hematoxylineosin.

Multicentric reticulohistiocytosis: a proliferation of macrophages with tropism for skin and joints, part I

The authors present part I of a review of multicentric reticulohistiocytosis, a rare systemic proliferative disease of histiocytes of unknown cause. It is clinically characterized by cutaneous and mucosal nodules and by osteoarticular lesions. The disease occurs in outbreaks that progress in severity, with spontaneous regression, but usually leaving incapacitating arthritis and disfiguring facial lesions. The authors discuss the historical, epidemiologic, and clinical aspects of this disease.

Multicentric reticulohistiocytosis

BACKGROUND

Multicentric reticulohistiocytosis (MR) is a rare histiocytic systemic disease mainly affecting the skin and synovia.

OBJECTIVE

To present the main and newest aspects of MR.

METHOD

A review of the current medical literature, composing a retrospective study of 96 case reports published world-wide since 1977.

RESULTS

Facial and hand skin nodules with symmetric arthritis were the most frequent clinical presentation. The pathognomonic sign of'coral beads' and vermicular erythematous lesions bordering nostrils, seems to be very characteristic of MR. There is a significant association with cancer. Histiocytic cells of MR are best characterized on immunohistochemistry by its immunoreactivity for vimentin, CD68 and CD45 and non-reactivity for S-100 protein, CD34 and factor XIIIa. Although the outcome of the disease is usually very limiting for the patients, treatment with immunosuppressive drugs may be useful.

CONCLUSION

MR is a unique histiocytic proliferative disease with a peculiar immunophenotypic pattern and distinctive clinical and histopathological aspects.

Multicentric reticulohistiocytosis: systemic macrophage disorder

Multicentric reticulohistiocytosis is a rare multisystem disorder that reflects a reactive inflammatory response to an undetermined stimulus. While the disease is characterized as a dermatoarthritis, multiple organ systems including cardiac and skeletal muscle, the pleura and gastrointestinal tract have been involved in reported cases. The synovitis can be quite destructive with arthritis mutilans developing in a substantial percentage. The dermatitis may be particularly disfiguring when the face is involved. This chapter describes the clinical and laboratory features of the 33 cases of MRH previously reviewed by Barrow and Holubar and an additional 33 cases that have appeared in the medical literature since that report. We note an apparent decline in frequency of some manifestations of MRH. This may be due in part to the nature of the recent reports which often present a brief clinical report and focus primarily on specific disease associations, unusual manifestations, new organ system involvement or treatment regimens. The primary cell involved in the reactive inflammatory response of MRH is the phagocytic tissue histiocyte (macrophage). While uncontrolled proliferation of these reticulohistiocytes is seen in several infectious and malignant conditions there is presently no direct evidence of a particular organism or neoplasm involved in the aetiopathogenesis of MRH. There is evidence of tuberculosis exposure in one third of cases with active tuberculosis present in 5%. Likewise, malignancies are reported concomitantly with MRH in 15-28% of cases. The therapeutic trend in MRH is to treat early and aggressively to prevent the devastating arthropathy and disfiguring cutaneous sequelae. This recommendation, however, is largely based on anecdotal reports and thus the physician encountering a case of MRH needs to proceed with circumspection.

Multicentric reticulohistiocytosis in a patient with malignant melanoma: a response to cyclophosphamide and a unique cutaneous feature

We describe a patient with multicentric reticulohistiocytosis and a history of malignant melanoma. His widely disseminated disease did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin graft. The multicentric reticulohistiocytosis progressed while the patient was taking nonsteroidal antiinflammatory agents, but showed significant response during a 10-month course of cyclophosphamide. While he was taking the cyclophosphamide, however, his melanoma recurred, and the patient subsequently died.

Multicentric reticulohistiocytosis, another lipid disorder with normolipidemic xanthomatosis?

This report describes a 72-year-old female patient with 2 types of severely disfiguring xanthomas, particularly on the facial area and the upper arms. Biopsy revealed xanthoma-type cells, histiocytes, and multiple giant cells. The soft yellowish facial xanthomata were rich in esterified cholesterol, whereas the cholesterol content of the colorless, firm, fibrous xanthoma of the arms was relatively low. The clinical course of insidiously starting polyarthritis, the formation of skin and tendon xanthomas (at the age of 63) and, finally, the histological findings verified the diagnosis of multicentric reticulohistiocytosis. The family history and findings were noncontributory. The patient had symptoms of moderate coronary heart disease and died from an acute myocardial infarction. Her total cholesterol and triglyceride levels were 182 and 89 mg/dl, and the HDL cholesterol value was 43 mg/dl. Plasma levels of apolipoprotein A-I, A-II and B were normal, and her apoprotein E pattern was E3/E3. The triglyceride/cholesterol ratio of VLDL, the concentration of apo-LDL (LDL protein) and the LDL-protein/cholesterol ratio were normal. The apo-LDL production, the total clearance rate of apo-LDL, and the receptor-mediated and receptor-independent catabolism of LDL were also normal. Fecal output of neutral sterols and bile acids and the total body cholesterol synthesis were normal, but cholesterol absorption tended to be increased. The response to cholestyramine treatment showed a 44% decrease in the serum cholesterol level and a normal 5-fold increase in cholesterol synthesis. The patient's xanthoma formation could not be associated with any of the causes known to promote the development of normolipidemic xanthomatosis. It is suggested that multicentric reticulohistiocytosis should be considered in the differential diagnosis of patients with normolipidemic xanthomatosis.