Acta Dermato-Venereologica 99-10CompleteContent | Page 33

935 Dense Papules on the Face: A Quiz Hongmei ZHOU, Qiang ZHAO, Lihong ZHAO, Qian SHANG, Jing LI and Songmei GENG* Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an 710004, China. *E-mail: [email protected] A 28-year-old man presented with multiple asymptomatic papules and plaques on his face for 3 months. He denied any drug intake, allergy or trauma history. A dermatological examination revealed clusters of yellowish-erythematous papules and plaques on his face and scalp (Fig. 1). No lymph­adenopathy or visceromegalies were found. Rou- tine laboratory tests, chest radiography and abdominal ultrasound revealed no obvious abnormalities. Biopsy of a lesion from his cheek showed a nodular mixed inflam- matory infiltrate throughout the dermis (Fig. 2a). The infiltration consisted of clustered large foamy-appearing histiocytes, numerous lymphocytes, plasma cells and few neutrophils. Emperipolesis in histiocytes was noted (Fig. 2b). Immunohistochemical studies showed that the pale cells were positive for S100 (Fig. 2c) and CD68, but nega- tive for CD1a. Specific stainings for microbial infections were negative. What is your diagnosis? See next page for answer. Fig. 1. Clusters of yellowish-erythematous papules, which partially coalesced into verrucous plaques on the patient’s face and nearby scalp. Written permission from the patient is given. QUIZ SECTION Fig. 2. (a) A dense nodular mixed inflammatory infiltrate in the dermis and subcutaneous tissue (haematoxylin and eosin; HE ×100). (B) The infiltration consisted of mainly large histiocytes with emperipolesis (black arrow), lymphocytes, and few neutrophils (HE ×400). (C) S100-protein was positive and confirmed emperipolesis (white arrow) (immunohistochemistry; IHC ×400). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3192 Acta Derm Venereol 2019; 99: 935–936