Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature

Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal...

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Autores principales:	Nadiya Chuchvara, Lauren Berger, Catherine Reilly, Amin Maghari, Babar Rao
Formato:	article
Lenguaje:	EN
Publicado:	Mattioli1885 2021
Materias:	reflectance confocal microscopy RCM Langerhans cells dendritic cells atypical cells Dermatology RL1-803
Acceso en línea:	https://doaj.org/article/bcf17fd3593a49f3a84370bb995e196b
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spelling	oai:doaj.org-article:bcf17fd3593a49f3a84370bb995e196b2021-11-17T08:27:55ZLangerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature10.5826/dpc.1103a782160-9381https://doaj.org/article/bcf17fd3593a49f3a84370bb995e196b2021-05-01T00:00:00Zhttp://dpcj.org/index.php/dpc/article/view/1541https://doaj.org/toc/2160-9381 Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation. Nadiya ChuchvaraLauren BergerCatherine ReillyAmin MaghariBabar RaoMattioli1885articlereflectance confocal microscopyRCMLangerhans cellsdendritic cellsatypical cellsDermatologyRL1-803ENDermatology Practical & Conceptual (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	reflectance confocal microscopy RCM Langerhans cells dendritic cells atypical cells Dermatology RL1-803
spellingShingle	reflectance confocal microscopy RCM Langerhans cells dendritic cells atypical cells Dermatology RL1-803 Nadiya Chuchvara Lauren Berger Catherine Reilly Amin Maghari Babar Rao Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
description	Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.
format	article
author	Nadiya Chuchvara Lauren Berger Catherine Reilly Amin Maghari Babar Rao
author_facet	Nadiya Chuchvara Lauren Berger Catherine Reilly Amin Maghari Babar Rao
author_sort	Nadiya Chuchvara
title	Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
title_short	Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
title_full	Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
title_fullStr	Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
title_full_unstemmed	Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature
title_sort	langerhans cells as morphologic mimickers of atypical melanocytes on reflectance confocal microscopy: a case report and review of the literature
publisher	Mattioli1885
publishDate	2021
url	https://doaj.org/article/bcf17fd3593a49f3a84370bb995e196b
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Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature

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