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Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection.

Cohen PR, Paravar T, Lee RA - Dermatol Pract Concept (2014)

Bottom Line: Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms.Epithelial and histiocytic multinucleated giant cell can occur in the epidermis.Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies.

View Article: PubMed Central - PubMed

Affiliation: Division of Dermatology, University of California San Diego, San Diego, California.

ABSTRACT

Background: Multinucleated giant cells in the epidermis can either be epithelial or histiocytic. Epithelial multinucleated giant cells are most often associated with herpes virus infections.

Purpose: To review the histologic differential diagnosis of conditions with epithelial and histiocytic multinucleated giant cells-since multinucleated giant cells in the epidermis are not always pathognomonic of a cutaneous herpes virus infection-and to summarize dermatoses in which herpes virus infection has been observed to coexist.

Methods: Two individuals with acantholytic dermatoses whose initial lesional skin biopsies showed multinucleated epithelial giant cells suggestive of a herpes virus infection are reported. Using the PubMed database, an extensive literature search was performed on multinucleated giant cell (and epidermis, epithelial, and histiocytic) and herpes virus infection. Relevant papers were reviewed to discover the skin conditions with either multinucleated giant cells in the epidermis or coincident cutaneous herpes virus infection.

Results: Initial skin biopsies from patients with either pemphigus vulgaris or transient acantholytic dermatosis mimicked herpes virus infection; however, laboratory studies and repeat biopsies established the correct diagnosis of their acantholytic dermatosis. Hence, epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection. Indeed, epithelial multinucleated giant cells in the epidermis can be observed not only in the presence of infection (herpes virus), but also acantholytic dermatoses and tumors (trichoepithelioma and pleomorphic basal cell carcinoma). Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms.

Conclusions: Epithelial and histiocytic multinucleated giant cell can occur in the epidermis. Keratinocyte-derived multinucleated giant cells are most commonly associated with herpes virus infection; yet, they can also be observed in patients with skin tumors or acantholytic dermatoses. Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies. However, when a herpes virus infection is suspected based upon the discovery of epithelial multinucleated giant cells in the epidermis, but either the clinic presentation or lack of response to viral therapy or absence of confirmatory laboratory studies does not support the diagnosis of a viral infection, the possibility of a primary acantholytic dermatosis should be considered and additional lesional skin biopsies performed. Also, because hematoxylin and eosin staining is not the golden standard for confirmation of autoimmune bullous dermatoses, skin biopsies for direct immunofluorescence should be performed when a primary bullous dermatosis is suspected since the histopathology observed on hematoxylin and eosin stained sections can be misleading.

No MeSH data available.


Related in: MedlinePlus

(A) Distant and (B) closer views of the repeat biopsy specimen that establish the diagnosis of pemphigus vulgaris. Acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils are present in an intraepidermal blister; eosinophilic spongiosis is present in the adjacent epithelium. Prominent eosinophils and occasional lymphocytes compose the perivascular infiltrate in the upper dermis (hematoxylin and eosin; a= ×20, b=×40). (Copyright: ©2014 Cohen et al.)
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f4-dp0404a03: (A) Distant and (B) closer views of the repeat biopsy specimen that establish the diagnosis of pemphigus vulgaris. Acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils are present in an intraepidermal blister; eosinophilic spongiosis is present in the adjacent epithelium. Prominent eosinophils and occasional lymphocytes compose the perivascular infiltrate in the upper dermis (hematoxylin and eosin; a= ×20, b=×40). (Copyright: ©2014 Cohen et al.)

Mentions: Microscopic examination showed an intraepidermal blister containing acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils; the adjacent epithelium showed spongiosis with eosinophils. Perivascular inflammation, consisting of prominent eosinophils and occasional lymphocytes, was present in the upper dermis (Figure 4). Direct immunofluorescence showed positive intercellular staining in the epidermis for IgG and C3. Subsequently, enzyme-linked immunosorbent assay (ELISA) testing demonstrated that the serum IgG titers were elevated for both desmoglein 1 and desmoglein 3.


Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection.

Cohen PR, Paravar T, Lee RA - Dermatol Pract Concept (2014)

(A) Distant and (B) closer views of the repeat biopsy specimen that establish the diagnosis of pemphigus vulgaris. Acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils are present in an intraepidermal blister; eosinophilic spongiosis is present in the adjacent epithelium. Prominent eosinophils and occasional lymphocytes compose the perivascular infiltrate in the upper dermis (hematoxylin and eosin; a= ×20, b=×40). (Copyright: ©2014 Cohen et al.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4230253&req=5

f4-dp0404a03: (A) Distant and (B) closer views of the repeat biopsy specimen that establish the diagnosis of pemphigus vulgaris. Acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils are present in an intraepidermal blister; eosinophilic spongiosis is present in the adjacent epithelium. Prominent eosinophils and occasional lymphocytes compose the perivascular infiltrate in the upper dermis (hematoxylin and eosin; a= ×20, b=×40). (Copyright: ©2014 Cohen et al.)
Mentions: Microscopic examination showed an intraepidermal blister containing acantholytic keratinocytes, numerous eosinophils, and occasional neutrophils; the adjacent epithelium showed spongiosis with eosinophils. Perivascular inflammation, consisting of prominent eosinophils and occasional lymphocytes, was present in the upper dermis (Figure 4). Direct immunofluorescence showed positive intercellular staining in the epidermis for IgG and C3. Subsequently, enzyme-linked immunosorbent assay (ELISA) testing demonstrated that the serum IgG titers were elevated for both desmoglein 1 and desmoglein 3.

Bottom Line: Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms.Epithelial and histiocytic multinucleated giant cell can occur in the epidermis.Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies.

View Article: PubMed Central - PubMed

Affiliation: Division of Dermatology, University of California San Diego, San Diego, California.

ABSTRACT

Background: Multinucleated giant cells in the epidermis can either be epithelial or histiocytic. Epithelial multinucleated giant cells are most often associated with herpes virus infections.

Purpose: To review the histologic differential diagnosis of conditions with epithelial and histiocytic multinucleated giant cells-since multinucleated giant cells in the epidermis are not always pathognomonic of a cutaneous herpes virus infection-and to summarize dermatoses in which herpes virus infection has been observed to coexist.

Methods: Two individuals with acantholytic dermatoses whose initial lesional skin biopsies showed multinucleated epithelial giant cells suggestive of a herpes virus infection are reported. Using the PubMed database, an extensive literature search was performed on multinucleated giant cell (and epidermis, epithelial, and histiocytic) and herpes virus infection. Relevant papers were reviewed to discover the skin conditions with either multinucleated giant cells in the epidermis or coincident cutaneous herpes virus infection.

Results: Initial skin biopsies from patients with either pemphigus vulgaris or transient acantholytic dermatosis mimicked herpes virus infection; however, laboratory studies and repeat biopsies established the correct diagnosis of their acantholytic dermatosis. Hence, epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection. Indeed, epithelial multinucleated giant cells in the epidermis can be observed not only in the presence of infection (herpes virus), but also acantholytic dermatoses and tumors (trichoepithelioma and pleomorphic basal cell carcinoma). Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms.

Conclusions: Epithelial and histiocytic multinucleated giant cell can occur in the epidermis. Keratinocyte-derived multinucleated giant cells are most commonly associated with herpes virus infection; yet, they can also be observed in patients with skin tumors or acantholytic dermatoses. Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies. However, when a herpes virus infection is suspected based upon the discovery of epithelial multinucleated giant cells in the epidermis, but either the clinic presentation or lack of response to viral therapy or absence of confirmatory laboratory studies does not support the diagnosis of a viral infection, the possibility of a primary acantholytic dermatosis should be considered and additional lesional skin biopsies performed. Also, because hematoxylin and eosin staining is not the golden standard for confirmation of autoimmune bullous dermatoses, skin biopsies for direct immunofluorescence should be performed when a primary bullous dermatosis is suspected since the histopathology observed on hematoxylin and eosin stained sections can be misleading.

No MeSH data available.


Related in: MedlinePlus