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Pediatric pathology (view source)

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→‎Juvenile xanthogranuloma
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{{Main|Dermatopathology}}
{{Main|Dermatopathology}}
==Juvenile xanthogranuloma==
==Juvenile xanthogranuloma==
*Abbreviated as ''JXG''.
{{Main|Juvenile xanthogranuloma}}
*[[AKA]] nevoxanthoendothelioma.
*In adults: ''adult xanthogranuloma''.<ref name=Ref_Derm622>{{Ref Derm|622}}</ref>
===General===
*Usually in children and infants, may be in adults.<ref name=Ref_Derm622>{{Ref Derm|622}}</ref>
*Most common form of non–Langerhans cell histiocytosis.<ref name=emed_jxg>URL: [http://emedicine.medscape.com/article/1111629-diagnosis http://emedicine.medscape.com/article/1111629-diagnosis]. Accessed on: 3 February 2011.</ref>
*Can rarely be found in the brain.<ref>URL: [http://path.upmc.edu/cases/case245/dx.html http://path.upmc.edu/cases/case245/dx.html]. Accessed on: 13 January 2012.</ref>
 
===Microscopic===
Features:<ref name=emed_jxg>URL: [http://emedicine.medscape.com/article/1111629-diagnosis http://emedicine.medscape.com/article/1111629-diagnosis]. Accessed on: 3 February 2011.</ref>
*Dermal histiocytes:
**Abundant cytoplasm - may not be xanthomatous/foam cells.
*+/-Touton [[giant cell]] - '''key feature'''.
**Large multi-nucleated cells where nuclei are distributed at the cell periphery.
 
DDx:
*[[Langerhans cell histiocytosis]].
*[[Spitz nevus]] - uncommon; reported to have Touton cells.<ref name=pmid18312437>{{Cite journal  | last1 = Guitart | first1 = J. | last2 = Gerami | first2 = P. | title = Touton-like giant cells in a Spitz's nevus. | journal = J Cutan Pathol | volume = 35 | issue = 7 | pages = 694-5 | month = Jul | year = 2008 | doi = 10.1111/j.1600-0560.2007.00877.x | PMID = 18312437 }}</ref>
*[[Dermatofibroma]], aneurysmal - has Touton [[giant cell]]s and hemosiderin deposition.
 
Notes:
*Must prove they are non-Langerhans cell histiocytes, esp. if no Touton giant cells.
 
====Images====
<gallery>
Image:Juvenile_xanthogranuloma_-_intermed_mag.jpg | Juvenile xanthogranuloma - intermed. mag. (WC)
Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg | Touton giant cells in a juvenile xanthogranuloma - very high mag. (WC)
</gallery>
===IHC===
Features:<ref name=emed_jxg/>
*Langerhans cell markers: CD1a, CD207 -- both should be negative.
**If Touton giant cells are absent -- this is essential.
*Histiocyte markers: CD68, CD163 -- both should be positive.
*Vimentin +ve.
 
Other markers:<ref name=pmid11285404>{{Cite journal  | last1 = Kraus | first1 = MD. | last2 = Haley | first2 = JC. | last3 = Ruiz | first3 = R. | last4 = Essary | first4 = L. | last5 = Moran | first5 = CA. | last6 = Fletcher | first6 = CD. | title = Juvenile xanthogranuloma: an immunophenotypic study with a reappraisal of histogenesis. | journal = Am J Dermatopathol | volume = 23 | issue = 2 | pages = 104-11 | month = Apr | year = 2001 | doi =  | PMID = 11285404 }}</ref>
*CD4 +ve (21 of 27 cases).
*CD45 +ve (25 of 27 cases).
*Factor XIIIa +ve (25 of 27 cases).
 
Negatives:<ref name=pmid9790615>{{cite journal |author=Thomas DB, Sidler AK, Huston BM |title=Radiological case of the month. Juvenile xanthogranuloma |journal=Arch Pediatr Adolesc Med |volume=152 |issue=10 |pages=1029–30 |year=1998 |month=October |pmid=9790615 |doi= |url=http://archpedi.ama-assn.org/cgi/content/full/152/10/1029}}</ref>
*Muscle markers: actin, desmin.
*Others: S100, factor VIII, cytokeratins.
 
===Sign out===
<pre>
SKIN LESION, CHIN, BIOPSY:
- JUVENILE XANTHOGRANULOMA.
</pre>


=Soft tissue lesions=
=Soft tissue lesions=
Michael
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