Case and Research Letters
Generalized Eruptive Multinucleate Cell Angiohistiocytoma in a Pregnant Woman: A Case Report and Review of the Literature
Angiohistiocitomas de células multinucleadas eruptivos y generalizados en una gestante. Presentación de un caso y revisión de la literatura
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Presentación de un caso y revisión de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "450" "paginaFinal" => "452" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Generalized Eruptive Multinucleate Cell Angiohistiocytoma in a Pregnant Woman: A Case Report and Review of the Literature" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1583 "Tamanyo" => 183532 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Múltiples máculo-pápulas eritematovioláceas, redondeadas de hasta 6-7<span class="elsevierStyleHsp" style=""></span>mm en el abdomen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.A. 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Villanueva, J.C. Tardío, A. Romero-Maté, J. Borbujo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C.A." "apellidos" => "Villanueva" "email" => array:2 [ 0 => "cvillanueva.hflr@salud.madrid.org" 1 => "candidavilleneuve@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.C." "apellidos" => "Tardío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Romero-Maté" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Borbujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiohistiocitomas de células multinucleadas eruptivos y generalizados en una gestante. Presentación de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 708 "Ancho" => 1900 "Tamanyo" => 362559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Multinucleate mesenchymal cells with angled cytoplasmic borders and small vessels with thickened walls and prominent endothelia located in the dermal collagen (hematoxylin-eosin, original magnification x400). B, Positive immune staining for estrogen receptor α in perivascular spindle-shaped cells (original magnification x400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Multinucleate cell angiohistiocytoma (MCAH) is a rare entity that takes the form of a benign dermatologic proliferation formed by small blood vessels and multinucleate mesenchymal cells. These lesions are probably underdiagnosed because of their similarity to other disorders, such as dermatofibroma, and because of their benign, asymptomatic nature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 35-year-old woman in the 36th week of her 4th pregnancy. The child born as a result of her second pregnancy had died 24<span class="elsevierStyleHsp" style=""></span>hours post partum. The woman had been visiting our department for many years due to multiple asymptomatic lesions on her trunk and extremities; the lesions first appeared during the first pregnancy and had increased in number over the course of the subsequent pregnancies. The physical examination revealed more than 100 round maculopapular lesions with diameters ranging between 2 and 8<span class="elsevierStyleHsp" style=""></span>mm; the lesions were erythematous-violaceous with a smooth surface and were distributed unevenly across the trunk and extremities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy showed a fine pigmented reticular pattern around the borders and a whitish central patch (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>); these findings were compatible with clinical suspicion of multiple eruptive dermatofibroma. Because this presentation of dermatofibroma has been associated with autoimmune disease, an immunological study was performed. The salient findings were the presence of anti-Ro 60 antibodies and antinuclear antibodies distributed in a speckled pattern.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy specimens of 2 papules revealed poorly defined lesions involving the full thickness of the dermis. Histology showed that the papules consisted of numerous small blood vessels with prominent endothelia distributed with no clear pattern throughout the dermal collagen. Other findings included scant perivascular histiocytes and lymphocytes and multinucleate mesenchymal cells characterized by fewer than 10 nuclei, no abnormalities, and a large cytoplasm with angular contours (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a). Immunohistochemical analysis showed estrogen receptor α expression in some perivascular spindle-shaped cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>b) and progesterone receptor expression in very few cells at the same location. Immune staining was negative for hormone receptors in the multinucleate cells. A diagnosis of generalized eruptive MCAH was reached.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The skin lesions were not treated because of the widespread nature of the outbreak. The patient was referred to obstetrics because of the positive anti-Ro 60 result and the history of the death of the newborn child after her earlier pregnancy. The neonate was monitored by the pediatrics department.</p><p id="par0025" class="elsevierStylePara elsevierViewall">MCAH is considered to be a dermal dendrocyte proliferation. Some authors consider it to be a variant of dermatofibroma<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>; as with dermatofibroma, it is difficult to determine whether MCAH is a true neoplasm or a reactive process.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> MCAH presents in healthy persons and reported associations with other diseases appear to be coincidental. Several factors support the idea that this is a reactive entity: the fact that some patients present with multiple lesions, the location of lesions in sites exposed to trauma and insect bites, the absence of a familial association, and the spontaneous regression reported in some cases. A link to hormone factors has been suggested, as these lesions present more frequently in women (79% of cases) and have been associated with overexpression of estrogen receptor α.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Including our patient, 5 cases of generalized MCAH have been reported to date: 3 men and 2 women<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> aged between 24 and 56 years with no associated disease. Of note in our case is the coincidence of the eruptive appearance of the lesions and each pregnancy, and the finding of anti-Ro 60 antibodies with a history of the death of a newborn baby.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The dermoscopy findings concur with those reported in the literature<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and are similar to the dermoscopy pattern of dermatofibroma. Multiple eruptive dermatofibroma has been linked to an abnormal immune system. In a review of 67 cases, Zaccaria et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> found a link with intercurrent disease in 96% of their cases, 83% of which were immune-deficient conditions. Those authors therefore suggested that the multiple eruptive presentation of dermatofibroma might be a diagnostic marker for immunosuppressive conditions. The cases reviewed included that reported by Stainforth and Goodfield<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> of a healthy woman who developed 9 dermatofibromas on the trunk during pregnancy; the authors included pregnancy as a condition involving immune-system abnormality. In light of our case, we suggest that the multiple eruptive form of MCAH may bear similarities to pregnancy-associated dermatofibroma.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we present the first case of generalized eruptive MCAH associated with every pregnancy in a woman who remained anti-Ro/SSA-positive and who has had no other associated symptoms to date. We suggest that this unique and rare clinical form of the disease may, in the future, be an indicator of an abnormal immune system and that it may support the association, suggested by some authors, of MCAH with hormone factors.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Villanueva CA, et al. Angiohistiocitomas de células multinucleadas eruptivos y generalizados en una gestante. Presentación de un caso y revisión de la literatura. Actas Dermosifiliogr.2012;103:450-2.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 950 "Tamanyo" => 100699 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple round erythematous-violaceous maculopapular lesions measuring up to 6 or 7<span class="elsevierStyleHsp" style=""></span>mm, on the abdomen.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1424 "Ancho" => 950 "Tamanyo" => 101561 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of a lesion, showing a fine reticular pattern mainly around the borders and a central whitish patch.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 708 "Ancho" => 1900 "Tamanyo" => 362559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Multinucleate mesenchymal cells with angled cytoplasmic borders and small vessels with thickened walls and prominent endothelia located in the dermal collagen (hematoxylin-eosin, original magnification x400). B, Positive immune staining for estrogen receptor α in perivascular spindle-shaped cells (original magnification x400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiohistiocitoma de células multinucleadas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Requena" 1 => "C. Requena" 2 => "R.O. Pichardo" 3 => "O.P. 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Lobo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.08.008" "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "231" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382607" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642007006574" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hallazgos dermatoscópicos del angiohistiocitoma de células multinucleadas; ¿una variante de dermatofibroma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Valerón-Almazán" 1 => "L. Dehesa" 2 => "N. Santana" 3 => "J. Vilar" 4 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 13 | 27 |
| 2024 October | 76 | 41 | 117 |
| 2024 September | 75 | 23 | 98 |
| 2024 August | 106 | 51 | 157 |
| 2024 July | 75 | 30 | 105 |
| 2024 June | 85 | 38 | 123 |
| 2024 May | 48 | 32 | 80 |
| 2024 April | 75 | 27 | 102 |
| 2024 March | 87 | 25 | 112 |
| 2024 February | 95 | 27 | 122 |
| 2024 January | 53 | 33 | 86 |
| 2023 December | 63 | 16 | 79 |
| 2023 November | 60 | 26 | 86 |
| 2023 October | 60 | 34 | 94 |
| 2023 September | 61 | 34 | 95 |
| 2023 August | 49 | 22 | 71 |
| 2023 July | 50 | 41 | 91 |
| 2023 June | 47 | 32 | 79 |
| 2023 May | 34 | 22 | 56 |
| 2023 April | 63 | 28 | 91 |
| 2023 March | 50 | 21 | 71 |
| 2023 February | 48 | 26 | 74 |
| 2023 January | 44 | 45 | 89 |
| 2022 December | 48 | 55 | 103 |
| 2022 November | 43 | 26 | 69 |
| 2022 October | 35 | 14 | 49 |
| 2022 September | 34 | 36 | 70 |
| 2022 August | 21 | 36 | 57 |
| 2022 July | 26 | 30 | 56 |
| 2022 June | 43 | 21 | 64 |
| 2022 May | 41 | 36 | 77 |
| 2022 April | 54 | 42 | 96 |
| 2022 March | 68 | 57 | 125 |
| 2022 February | 48 | 24 | 72 |
| 2022 January | 50 | 29 | 79 |
| 2021 December | 33 | 35 | 68 |
| 2021 November | 44 | 45 | 89 |
| 2021 October | 39 | 48 | 87 |
| 2021 September | 39 | 30 | 69 |
| 2021 August | 36 | 25 | 61 |
| 2021 July | 40 | 28 | 68 |
| 2021 June | 29 | 33 | 62 |
| 2021 May | 33 | 35 | 68 |
| 2021 April | 59 | 46 | 105 |
| 2021 March | 68 | 31 | 99 |
| 2021 February | 46 | 37 | 83 |
| 2021 January | 15 | 24 | 39 |
| 2020 December | 33 | 9 | 42 |
| 2020 November | 18 | 18 | 36 |
| 2020 October | 18 | 9 | 27 |
| 2020 September | 23 | 14 | 37 |
| 2020 August | 17 | 22 | 39 |
| 2020 July | 23 | 11 | 34 |
| 2020 June | 24 | 20 | 44 |
| 2020 May | 19 | 11 | 30 |
| 2020 April | 34 | 19 | 53 |
| 2020 March | 27 | 19 | 46 |
| 2020 February | 6 | 0 | 6 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 1 | 5 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 10 | 10 |
| 2019 September | 4 | 10 | 14 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 4 | 3 | 7 |
| 2019 June | 4 | 9 | 13 |
| 2019 May | 4 | 15 | 19 |
| 2019 April | 2 | 10 | 12 |
| 2019 March | 0 | 6 | 6 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 0 | 4 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 42 | 4 | 46 |
| 2018 January | 61 | 5 | 66 |
| 2017 December | 61 | 8 | 69 |
| 2017 November | 43 | 10 | 53 |
| 2017 October | 42 | 5 | 47 |
| 2017 September | 54 | 8 | 62 |
| 2017 August | 69 | 14 | 83 |
| 2017 July | 57 | 3 | 60 |
| 2017 June | 72 | 28 | 100 |
| 2017 May | 65 | 17 | 82 |
| 2017 April | 47 | 11 | 58 |
| 2017 March | 49 | 18 | 67 |
| 2017 February | 43 | 12 | 55 |
| 2017 January | 36 | 6 | 42 |
| 2016 December | 93 | 10 | 103 |
| 2016 November | 54 | 10 | 64 |
| 2016 October | 87 | 16 | 103 |
| 2016 September | 141 | 19 | 160 |
| 2016 August | 49 | 11 | 60 |
| 2016 July | 45 | 9 | 54 |
| 2016 June | 15 | 19 | 34 |
| 2016 May | 12 | 11 | 23 |
| 2016 April | 6 | 1 | 7 |
| 2016 March | 9 | 12 | 21 |
| 2016 February | 4 | 17 | 21 |
| 2016 January | 4 | 11 | 15 |
| 2015 December | 13 | 1 | 14 |
| 2015 November | 41 | 14 | 55 |
| 2015 October | 43 | 13 | 56 |
| 2015 September | 20 | 1 | 21 |
| 2015 August | 16 | 1 | 17 |
| 2015 July | 139 | 12 | 151 |
| 2015 June | 81 | 9 | 90 |
| 2015 May | 96 | 9 | 105 |
| 2015 April | 75 | 12 | 87 |
| 2015 March | 64 | 10 | 74 |
| 2015 February | 80 | 10 | 90 |
| 2015 January | 67 | 14 | 81 |
| 2014 December | 67 | 13 | 80 |
| 2014 November | 54 | 7 | 61 |
| 2014 October | 72 | 12 | 84 |
| 2014 September | 56 | 9 | 65 |
| 2014 August | 76 | 15 | 91 |
| 2014 July | 92 | 19 | 111 |
| 2014 June | 122 | 17 | 139 |
| 2014 May | 51 | 5 | 56 |
| 2014 April | 30 | 2 | 32 |
| 2014 March | 28 | 7 | 35 |
| 2014 February | 32 | 4 | 36 |
| 2014 January | 40 | 4 | 44 |
| 2013 December | 28 | 9 | 37 |
| 2013 November | 29 | 8 | 37 |
| 2013 October | 21 | 4 | 25 |
| 2013 September | 30 | 8 | 38 |
| 2013 August | 28 | 6 | 34 |
| 2013 July | 9 | 11 | 20 |
| 2013 June | 14 | 13 | 27 |
| 2013 May | 18 | 13 | 31 |
| 2013 April | 14 | 8 | 22 |
| 2013 March | 10 | 9 | 19 |
| 2013 February | 46 | 3 | 49 |
| 2013 January | 35 | 4 | 39 |
| 2012 December | 30 | 3 | 33 |
| 2012 November | 0 | 1 | 1 |
| 2012 August | 2 | 1 | 3 |
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