207Indian Journal of Dermatology, Venereology, and Leprology | March-April 2012 | Vol 78 | Issue 2

Named cells in dermatology

Fiona F. Sequeira, Suneil Gandhi1, Usha Kini2, Ishwar Bhat

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How to cite this article: Citation will be included before issue gets online***

Received: August, 2011. Accepted: November, 2011. Source of Support: Nil. Conflict of Interest: None declared.

INTRODUCTION

This article briefly describes the named cells in dermatology. It‘s purpose is to serve as a ready reckoner to the postgraduates during their quiz preparations. They include the following:A. General category1. Normal cutaneous anatomy: Langerhans cells,

Glomus cells, Veil cells, Mast cells2. Bullous disorders: Tzanck cells

3. Eczematous disorders: Tadpole cells4. Metabolic and storage disorders: Gargoyle cells,

Gaucher’s cell, Xanthoma cells5. Tumors: Basalioma cells, Basophilic and shadow

cells, Doughnut cells, Flower cells, Granular cells, Halo cells, Hibernoma cells, Paget cells, Sezary cells, Signet ring cells, Spider web cells, Strap cells, Reed Sternberg cells, Vulvar Clear Cells of Toker, Floret giant cells

6. Histiocytic disorders: Touton giant cells

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Departments of Dermatology and 2Pathology, St John’s Medical College and Hospital, Bangalore, Karnataka, 1Department of Dermatology, JN Medical College, Belgaum, India

Address for correspondence: Dr. Fiona F. Sequeira, Department of Dermatology, St John’s Medical College and Hospital, Koramangala, Bangalore, Karnataka - 560 034, India. E-mail: dr_fiona@rediffmail.com

Table 1: Under general and infectious category

Name Description/location/size LM/EM Stains/markers Observed in/significanceLangerhanscell NamedafterPaulLangerhans.Isapale-

stainingnon-keratinocyte,withaconvolutednucleus.Itscytoplasmcontainsvimentinintermediatefilamentsandsmallrod-orracket-shapedstructurescalledLangerhanscellgranulesorBirbeckgranules[1]

LMEM

HandECD 1aS-100Langerin(CD207)

Aredistributedintheepidermis(preferenceforasuprabasalposition),oralcavity,esophagusandvagina.[1]Theyserveastheantigen-processingandpresentingcells.[1]

Theyarereducedintheepidermisofpatientswithdiseaseslikepsoriasis,sarcoidosisandcontactdermatitis,andincreasedinlangerhanscellhistiocytosis.

Glomuscell Theyarelargepolyhedralcellswitharound,centrally locatednucleusandapaleeosinophiliccytoplasm.[2] Thecellsareofsmoothmuscleorigin.Theycompriseofspecializedvascularstructurescalledglomusformations.[2] Theseformationshaveanarterialandvenoussegmentwithoutinterveningcapillaries

LMEM

HandEMyosinVimentin

Glomustumorsandglomangiomasarisefromthearterialsegmentofthecutaneousglomus,theSuquet-Hoyercanal.[2] Glomusformationsarespecialarteriovenousshuntsthatappeartoplayaroleinthermoregulation.[2]

Veilcell Theseareflatadventititalcellswithdistinctivenuclearstructureandprominentcytoplasmicprocessesthatsurroundthedermalmicrovessels.[3]Theylieexternaltothewall,demarcatingthevesselfromthesurroundingdermis.TheyexpressfactorXIIIaandVonWillebrandfactor[3]

LMPhase contrastEM

HandE It isstrategicallypositionedintheorganizationofthemicrovesseltoparticipateinthecontrolofbleedingatthemicrovascularlevel.[4]

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Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceMastcell Areroundtospindleinshapewitha

unilobedroundtoovalcentrallypositionednucleus.Itssizevariesupto5–13µm.Theycontainintheircytoplasmgranulesthatrangefrom0.3to0.8mm[5]

Mastcellssynthesizeanimpressiverepertoireofmediators,someofthemincludinghistamine,heparin,tryptase,chymase,carboxypeptidase,neutrophilchemotacticfactorandeosinophilicchemotacticfactorofanaphylaxis[5]

LMEM

HandE,Metachromaticstainingwithtoluidineblue,methyleneblue,alcianblueandGiemsa:Red-purple,Lederstain,MastcelltryptaseandChymaseCD117

Intheskin,mastcellsarepresentingreatestdensityinthepapillarydermis,neartheDEJ,insheathsofepidermalappendages,andaroundbloodvesselsandnervesofthesubpapillaryplexus.Theyarealsocommoninthesubcutaneousfat[1]

Activatedmastcellsaretheprimaryeffectorcells intheonsetofanallergicreaction.Theyplayaroleinthedefenseagainstparasites,stimulatechemotaxis,activation,andproliferationofeosinophils,promotephagocytosis,altervasotensionandvascularpermeabilityandstimulateconnectivetissuerepairandangiogenesis[1]

Theirnumbersareincreasedinmastocytosis.

Tastzellencells,Merkelcells

NamedaftertheGermananatomistFriedrichSigmundMerkel.Thesenon-keratinocytesareoval inshape,haveapale-stainingcytoplasmcontainingbundlesof intermediaryfilamentsandosmiophilicgranules.Thenucleusislargeandlobulated,andthemarginsofthesecellsprojectcytoplasmic“spines”towardthekeratinocytes[1]

LMEM

Silverimpregnation,CAM5.2orAE1/AE3,CK20,Neuron-specificenolase(NSE)

Theyarefoundbothinhairyskinandintheglabrousskinofthedigits,lips,regionsoftheoralcavityandtheouterrootsheathofthehairfollicle.Merkelcellsareslow-adapting,typeImechanoreceptors.MerkelcellcarcinomaisamalignanttumorofMerkelcells[6].

Tzanckcells/acantholyticcells/mourningedgedcells

It isnamedafterArnaultTzanck,aFrenchdermatologist.Thesearelarge,roundkeratinocyteswithanenlargedhyperchromaticnucleus,hazyorabsentnucleoliandabundantbasophiliccytoplasm.Thebasophilicstainingisdeeperperipherallyonthecellmembrane(“mourningedged”cells)duetothecytoplasm’stendencytogetcondensedattheperiphery, leadingtoaperinuclearhalo.[7] Incontrasttopemphigusvulgaris,theacantholyticcells inpemphigusfoliaceusandpemphiguserythematosusoftenhaveahyalinizedcytoplasmthatcorrespondstothedyskeratosisseenintissuesections

LM HandE,Giemsa,Papanicolaoustain,Wright,Methyleneblue,Toluidine blue

Pemphigus.Thisisaformofprimaryacantholysis.TheotherexamplesincludeDariers’sdisease,transientacantholyticdermatosesandwartydyskeratoma.Whenacantholysisoccurssecondarytosomealteration/damagetoepidermalcells,thetermsecondaryacantholysisisused.E.g.,bullousimpetigo,herpessimplex/zosterandsquamouscellcarcinoma.

Tadpolecells Arecellswitha“tadpole-like”shape.Presenceofmorethan10tadpolecells inaTzancksmearat×100magnificationisadiagnosticindicatorforspongioticvesiculardermatitis[8,9]

LM HandE Spongioticvesiculardermatitis.E.g.,allergiccontactdermatitis.

Gargoylecells/Hurlercells

Alargeovalorpolygonalcell,20µmindiameter,withapalecentralnucleus,thecytoplasmappearingclearonHandEstaining.Whenstainedwithtoluidineblue,metachromaticgranulesareseeninthecytoplasm.[10]OnEM,thecytoplasmoftheclearcells isseentobefilledwithlargeirregularclearvacuolesvaryinginsizefrom0.5μmto2μm.Themembranesofthevacuolesareoftenbrokenandtherupturedendscurl.Occasionally,mitochondriaandcisternsofendoplasmicreticulumareinterspersedbetweenthevacuoles

LMEM

HandE,Toluidineblue,Alcianblue

AreseeninHurlersyndrome.

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209Indian Journal of Dermatology, Venereology, and Leprology | March-April 2012 | Vol 78 | Issue 2

Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceGauchercells ThediseaseisnamedaftertheFrench

doctorPhilippeGaucher.Gauchercellsareglucocerebroside-ladenmacrophagesmeasuring50–60μmindiameter.Onelectronmicroscopy,theycontaintubularcytoplasmicinclusionsthatareconsideredtobetransformedsecondarylysosomes.Thefibrillarceramideaccumulationsareextensiveenoughtogivethecytoplasmadistinctive“crinkledbluetissuepaper”appearance[11,12]

LMEM

Wrightstain,PAS+,Ironstains

Gaucher’sdiseaseisaninheriteddisorderofceramidemetabolisminwhichanenzymedeficiencyleadstotheaccumulationofglucocerebrosideinmacrophagesofthebonemarrow,reticuloendothelialsystembutnottheskin.ThesecellsarenotdiagnosticofGaucherdisease.Cutaneousmanifestationofthisconditionincludepatchypigmentationoftheskinandpetechiae.

Xanthomacells Oftenwithinthesamelesionit’sappearancecanvaryfromeosinophilictocleartofoamyortomultinucleatedgiantcells,whichareoftenreferredtoasToutongiantcells[13]

LMEM

HandE,FatstainssuchasoilredOorSudanblackBarerequiredtovisualizelipiddropletsonfrozensections

Variousxanthomatoses,familialhyperlipoproteinemiatypesIIa,IIIandV,cerebrotendinousxanthomatosis,Wolman’sdisease,Tangierdisease,Hand–Schuller–Christiandiseaseandnormolipidemiccutaneousxanthomatosis.

Basaliomacells Trichoepitheliomascontainanepithelialcomponentcomposedofuniformsmallbasophiliccells lookinglikeepidermalbasalcellswithroundnucleiandcytoplasm.Theyarearrangedinstrandsandlobules.Theydisplayperipheralpalisadingandsometimescontainhorncystsorcalcifications[14,15]

LM HandE Trichoepitheliomas,BCC.

Basophilicandshadoworghostcells

Pilomatricomasaresharplydemarcatedtumorsthatpossesstwotypesofcells:Basophiliccellsandeosinophilicshadowcells.Theformerhaveroundorelongated,deeplybasophilichyperchromaticnucleiandscantycytoplasmsothatnuclei lieclosetoeachother.Thelatterareanucleate,eosinophilic,keratinizedcellshavingadistinctborderandpossessingacentralunstainedareaasashadowofthelostnucleus.Thesecellsfrequentlycalcify[16]

LM HandE Pilomatricomas.

Doughnutcells Theyaretheintranuclearcytoplasmicinclusionsinthelargeanaplasticmononuclearcells.[17]

Theseinclusionsaretheresultofdeepcytoplasmicinvaginationsintothenuclei.Nuclearindentation>70%ofthetotalnucleardiameteristhecriteriontotermitasahalf-doughnutcell[18]

LM HandEPapanicolaou,May-Grunwald,Giemsa,CD30+,Clusterin

Anaplasticlargecell lymphoma.

Flowercellsorcloverleafcells

Areperipheralbloodatypical lymphocytescharacterizedbyhavingirregularnuclearcontours,prominentnucleoli,condensedchromatinanddeeplybasophilic,occasionallyvacuolatedcytoplasm[19]

LM HandE,CD25+

AdultTcell lymphoma(ATL)isanaggressivematureT-cellmalignancycausedbyHTLV-I.Itaffectstheskinin43–72%ofthecases.Thediseasemanifestsitself intheskinaserythroderma,plaques,papules,nodulesandtumors.[20]These so-calledflowercellsareconsideredpathognomonicofATLandareseenintheperipheralbloodofthesepatients.[21]

Granularcells Arelargepolygonalcells inthedermiswithdistinctcellmembranesandprominenteosinophilicgranularcytoplasm.Thenucleiareusuallysmall,roundtoovalandcentrallylocated[22]

LM HandE,GranulesarePAS+diastase-resistant

Granularcelltumor,consideredtobeofperipheralnervesheathorigincaninvolvevariouspartsofthebody(skinandtonguebeingthemostcommonorgansinvolved).

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Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceHalocells Intraepidermallymphocytesthatare

largerthanthenormallymphocyteswithconvoluted,cerebriformnucleiandaclearrimofcytoplasm[23]

LM HandE Areseeninmycosisfungoides.

Hibernoma-likecells,Mulberrycells,multivesicularcells

Are large(average-54microns) fatcellscontainingacentralnucleuswithamultivacuolatedscantygranular,eosinophiliccytoplasm.[24] The main histopathologicdifferentiationofadultadiposetissuefromhibernomacells isthepresenceofaclearcytoplasmandaneccentricnucleus[Figure1]

LM HandE Anuncommonneoplasmderivedfrombrownfat,[25] areseenmostlyinadults,withapredilectionforthethigh,back,axilla,neckandintrathoracicregion.

Pagetcells Areroundorovalcellsthatappearlargerthanthekeratinocytes.Theyhaveavacuolatedamphophilic,cytoplasmwithahypertrophicnucleus,scantynuclearchromatinandalargenucleolus.NodesmosomalattachmentsareseenbetweenPagetcellsandtheadjacentkeratinocytes[26]

LM HandE,PAS+

FoundinPaget’sdiseaseofthebreast.

Sezarycells,Lutznercells,Mycosiscell,Cerebriform lymphocytes,AtypiacellulesmonstreusesorMonstercell

FirstdescribedbyAlbertSézary.Areatypical lymphocyteswithagroovedorcerebriformnucleus.Thenuclearchromatiniscondensed inapatchydistributionbeneath thenuclearmembrane.Thenucleolimaybeprominent.Thecytoplasmissparseandappearsasanarrowrimaroundthenucleus.Mitochondria(oftenappearingclumped), roughendoplasmicreticulum,polysomesandcytoplasmicfibrilsareseen.Thecytoplasmicfibrilsappearserpentineonelectronmicroscopicexamination.Thesmallerversionsof thesecellsarecalledLutznercellsandthe largeronesasclassicalSezarycells[27,28]

LMEM

Wright,Giemsa,PAS

SeeninmycosisfungoidesandSezarysyndrome(bothintissueandinblood).

Signetringcells Thesecellshaveasinglelargevacuolefullofmucin.Thisvacuoledisplacesthehyperchromaticnucleustotheperiphery.[29]

Thepoolofmucininasignetringcellmimicstheappearanceofafingerhole,andthenucleusmimicstheappearanceofthefaceoftheringinprofile[Figure2]

LM HandE,Alcianblue,Mucicarmine

Areseeninmucin-producingadenocarcinomas.

Spiderwebcells Arepolygonalorovoidtumorcellsthatexhibitcytoplasmicvacuolesduetotheirglycogencontent.Residualstrandsofcytoplasmbetweenthevacuolesdefinespiderwebcells[30,31]

LM HandE Adultrhabdomyomas.

Strapcells Cellswithelongatedeosinophiliccytoplasm[32] LM HandE Aresuggestivebutnotdiagnosticofrhabdomyosarcoma.

ReedSternbergcells

TheyarenamedafterDorothyReedMendenhallandCarlSternberg.Arelargecellsthatareeithermultinucleatedorhaveabilobednucleus(resemblingan“owl’seye”appearance)withprominenteosinophilicinclusion-likenucleoli[33,34][Figure3]

LM HandE,CD30,CD15

Thepresenceofthesecells ispathognomonicforthediagnosisofclassicalHodgkin’slymphoma(HL).OtherthanHL,cellsresemblingReed-SternbergcellsmaybepresentinotherBandTcell lymphomas,carcinomas,melanomasandsarcomas.TheprevalenceofskininvolvementinHLisapproximately0.5–3.4%.

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211Indian Journal of Dermatology, Venereology, and Leprology | March-April 2012 | Vol 78 | Issue 2

Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceVulvarclearcellsofToker,intraepidermalglandularcells

ClearcellsofTokerareintraepithelialcellswithcleartopalestainingcytoplasmandblandcytologicfeatures.Theyarefoundintheepidermisofthenipple, immediatelyadjacenttotheopeningsofthelactiferousducts,alongthebasal layeroftheepidermisorscatteredinthestratumMalpighii.Tokercellsaredistributedassingleunitsorassmallaggregatesthatoccasionallyformsmall lumina.Theyhavebeenconsideredaprimitiveorgerminativecellofthelactiferousductorinterepithelialextensionofthelactiferousductcells[35,36]

LM HandE,CK7,EMA

Foundinapproximately10%ofnormalnipples.ClearcellsofTokerhavegeneratedinterestasapossibleprecursorcellofprimaryintraepidermalextramammaryPaget’sdisease,asmorphologicallytheyappeartobeabenigncounterpartofthemalignantcellsofPaget’sdisease.

Floretgiantcells Thesearemultinucleatedgiantcellsthathavemarginal,oftenoverlappingnucleiandaneosinophiliccenter[37]

LM HandE,Vimentin,CD34

Seeninpleomorphiclipoma,giantcellcollagenoma,giantcellfibroblastoma,giantcellangiofibroma,neurofibromatosistype1.

Toutongiantcells

Thesecellshaveaperipheralwreath-likearrangementofnuclei,withamphophiliccytoplasmcentrallyandpale,foamycytoplasmattheperipheryofthecelloutsidethenuclei[38]

LM HandE Seeninxanthoma,disseminatedxanthoma,juvenilexanthogranuloma,necrobioticxanthogranulomaanddermatofibroma

Hobnailcells Areplumpendothelialcellswithscantycytoplasmandenlargedprominent,hyperchromaticnucleiwithoneortwominutenucleoli.Theseendothelialcellsaredisposedinamonolayer,withnucleibulgingintothevascularlumina,resultinginacharacteristichobnailormatchstickappearance[39]

LM HandE Hobnailhemangiomaisararebenignvasculartumor.Itusuallyappearsasasingle,small,well-circumscribed,angiomatousorbrownish,flatorexophyticskinlesion.

LEcell TheLEcell istheendresultofeitherphagocytosisofdistortednuclearmaterialbyapolymorphonuclearleukocyteorautolysisofoneormorelobesofthenucleus[40,41]TheLEcellcontainswithinitscytoplasmtheLEbody,whichappearsasahomogenous,palebluetodeep-purplishmaterialpushingthenucleusofthephagocytetoonesideofthecell[Figure4].

LM Romanowskystains SLE.LEcellsarenotusuallyfoundinperipheralblood,althoughtheLEcellphenomenoncouldforminthebuffycoatofperipheralbloodafteraperiodof incubation.

Tartcells Atartcell isamonocytethathasengulfedanintact lymphocytenucleus.ItdiffersfromanLEcellbecausethesecondarynucleusretainsitsdefinitechromatinstructure[40,42]

LM Romanowskystains It isnotdiseasespecific.

Podophyllincells Bizarre,enlargedepithelialcellswitheitheraclumpedpyknoticnucleusorwiththenuclearchromatindisintegratedanddispersedassmallgranulesthroughoutthecytoplasmofthecell.These“podophyllincells”resemblecarcinomacells,butmaybedistinguishedfrommalignancybytheabsenceofcytologicatypiaandmultinucleategiantcells[43]

LM HandE Seenaftertheapplicationofpodophyllintonormalskin,verrucavulgarisandcondylomaaccuminata.

Mantlecells/corpsronds

Corpsrondsaredykeratotickeratinocyteswithasmallpyknoticnucleus,acidophiliccytoplasmandaperinuclearhalo(“mantlecells”)[7].Theyareseeninthestratumgranulosumanduppermalpighianlayer

LM HandE Darier disease.

Halfandhalfcells

Thesearetransformedkeratinocyteswhichshowincreasedsyntheticactivityinonehalfofthecell,andfibrillardegenerationintheotherhalfofthecell(resemblingthatofcolloidbodies).[44]

EM Phosphotungsticacid

Thesecellsareseeninlichenplanus,andarebelievedtoprovideausefulcluetotheearlychangesoccurringincolloidbodyformation.

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Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceBeanbagcells Theyaremacrophagesthatbecome

engorgedbyphagocytosisoferythrocytes,lymphocytesandcellfragments[45]

LM HandE Seeninhistiocyticcytophagicpanniculitis.

Sunburncells Arepink,deadordyingkeratinocytescharacteristicofmammalianepidermisafterexposuretoUVCandUVBradiationorUVAradiationinthepresenceofpsoralens.Thesecellshaveapyknoticnucleusandashrunkenglassyeosinophiliccytoplasmandareseenscatteredthroughouttheepidermis[46]

LM HandE SeeninsunburnsandPUVA-inducedacutephototoxicity.

Ballooncells Thesearepolyhedralcellswithamplemicrovesicularcytoplasm,(ultrastructurallycorrespondingtoenlargedvacuolatedmelanosomes)sparsetoabsentpigment,distinctcytoplasmicmembranesandsmall,hyperchromatic,roundtoslightlyscallopedcentralnucleiandrareintranuclearvacuolesorpseudoinclusions[47,48]

LM HandE Ballooncellnevus.

Pekincells,Reitercells

Aremacrophages40µminsize.Theycontainoneormoreintactpolymorphonuclearleucocytesanddeepstainingbasophilicglobularstructureswithinthecytoplasm[49]

LM HandE InReiter’sdisease(50–70%ofsynovialfluidspecimens)aswellasanyotherinflammatorysynovialdisease.

Cluecells Aresquamousepithelialcellswithalargenumberofcoccobacillaryorganisms,Gardnerella vaginalisandotheranaerobicbacteriadenselyattachedinclusterstotheirsurfaces,givingthemagranularappearance.Thecytoplasmappearsfuzzy(likeshadingwithblackpencil)andtheedgesofthesquamousepithelialcells,whichnormallyhaveasharplydefinedcellborder,becomeindistinctorstippled[50][Figure5]

LM Papanicolaou,Gram Seeninbacterialvaginosis.Tobesignificantforbacterialvaginosis(BV),morethan20%oftheepithelialcellsonthewetmountshouldbecluecells.

Downeycells/Turkcells

NamedafterHalDowney.Areatypicallymphocytes,which,unlikeleukemiccells,showextremevariabilityofsizeandshape.Theyhaveabundantpalebluecytoplasm.Thenucleusmaybeirregularorindentedwithlightlystainingchromatin.Cytoplasmicedgesmaybeindentedbyotherbloodcells,leadingtoascallopedappearancecalledDutchskirting[51-53]

Oilimmersion

HandE,Giemsa

Seenintheperipheralbloodofinfectiousmononucleosispatients.Thedetectionofatleast10%atypicallymphocytesonaperipheralbloodsmearinapatientwithmononucleosishasasensitivityof75%andaspecificityof92%forthediagnosisofinfectiousmononucleosis.

GreenblattandPundcells

Arelargemononuclearcellsmeasuring25–90mmindiameter.Thenucleusofthecelliseccentricallyplaced,vesicularorpyknotic.Thereare<20intracytoplasmicvacuolescontainingDonovanbodiesineitheryoungnon-capsulatedormaturecapsulatedforms[54,55]

LM Giemsa,Leishman,Wright

Seen in granuloma inguinale.

Lepracells/Virchowcells

NamedafterRudolphVirchow.Lepracellswhenstudiedbymeansofvitalstainingarefoundtobederivedfromthehistiocyteoftheinfectedtissue.Theirprotoplasm,whichformsthegreaterpartofthecell,isfilledwithvacuoles,andcontainsenormousnumbersofleprabacilli.Thenucleusisusuallysingleandis,asarule,pressedtoonesidebythevacuolesandbacillithatcrowdthecellbody.Insomeinstances,thesevacuolesaresonumerousthatthereislittleactualprotoplasmremaining,thecellbodyhavingtheappearanceofafoam.[56]Intimeandwithantimycobacterialtherapy,degeneratebacilliaccumulateinthemacrophages,theso-calledlepracells,whichthenhaveafoamyorvacuolatedcytoplasm[Figure6]

LM ModifiedFiteFaracostain

TheyareobservedinlepromatousleprosyTheyresemblexanthomacellsand,onstainingwithfatstains,areshowntocontainlipid, largelyneutralfat,andphospholipidsratherthancholesterol [57]

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213Indian Journal of Dermatology, Venereology, and Leprology | March-April 2012 | Vol 78 | Issue 2

Table 1: (Continued)

Name Description/location/size LM/EM Stains/markers Observed in/significanceMickuliczcells Alargehistiocytemeasuring10–100mm

indiameter.Ithasapale,vacuolatedcytoplasm.Withinthecytoplasmofthesecells,onefindsmanyKlebsiellabacilli[58]

LM Giemsa,Gram,Warthin-starrysilver,PAS+

Thecharacteristiccell inrhinoscleroma.

VonHansemanncells

NamedafterDavidPaulVonHansemann.Arelargemacrophageswithabundantfoamyeosinophiliccytoplasmandaprominenteccentric,hyperchromaticroundnucleus.Variablenumbersof intracytoplasmic,concentrically laminated,round–ovoid,basophilic inclusionsareappreciatedandarereferredtoasMichaelis–Gutmannbodies[59]

LM HandE,PAS-positive,Diastaseresistant

Seen in malakoplakia.

Langhansgiantcells

NamedafterTheodorLanghans,aGermanpathologist.Theyareformedbythefusionofepithelioidcellsandcontainmultiplenucleiarrangedinahorseshoe-shapedpatterninthecellperipheryorarearrangedcircumferentially[60]

LM HandE Seenintuberculoidgranulomas.E.g.,tuberculoidleprosy,cutaneoustuberculosis,gummaofsyphilisandsporotrichosis.

Wrightcells Arelargemacrophagesthatcontainnumerousprotozoagroupedtogetherinatypical“swarmofbees”fashionwithintheweaklybasophiliccytoplasm[61]

LM MayGrunwald,Giemsa

Seenincutaneousandmucosalleishmaniasis.

WarthinFinkeldeycells

Atypeofgiantcellthatvaryinsize,butcancontainasmanyas100nucleipercellalongwithcytoplasmicandnuclearinclusions[62]

LM HandE Pathognomicformeaslesinfection.Foundinreticuloendothelialsystem,exanthem,Koplikspotsandrespiratorysecretions.

Koilocytes Arehumanpapillomavirus-infectedvacuolatedkeratinocytesthatbearabasophilicpyknoticnucleussurroundedbyaclearhaloandpale-stainingcytoplasm.Theyarelocatedintheupperstratummalpighiiandinthegranularlayer.Theycontainfewornokeratohyalinegranules[63]

LM HandE Verrucavulgaris.

Mitosoidcells Arekeratinocyteswithirregularlyshapedhyperchromaticnucleithatsimulatemitoses.Theyareinfactdegeneratednucleiwithoutmitoticability[64]

LM HandE Infocalepithelialhyperplasia(Heckdisease).

LM:Lightmicroscopy,EM:Electronmicroscopy

Figure 1: Hibernoma. Large polyhedral fat cells containing eosinophilic granular cytoplasm (×200)

Figure 2: Signet ring cells in an adenocarcinoma. Sheet of large cells with vacuolated cytoplasm pushing the single hyperchromatic nucleus to the periphery (×400)