Reactive granular histiocytosis secondary to arthroplasty prosthesis: a novel reaction pattern

Abstract

A reactive histiocytic infiltrate can be seen as an incidental finding in a lymph node biopsy from a patient with a history of joint arthroplasty. We report the case of a 74-year-old female who underwent surgical revision of a polyethylene-based right total knee prosthesis due to chronic wear. At the time of surgery, a soft tissue mass adjacent to the tibial prosthetic insert was noted and excised. Histopathologic examination revealed a sheet-like proliferation of large, histiocytoid cells within the subcutis and superficial fascia. The cells showed abundant eosinophilic, granular cytoplasm and small round bland nuclei. Immunohistochemical evaluation revealed the cells to be positive only for CD68. In addition, abundant PAS-positive cytoplasmic granules were found, and minute particles of polarizable material were noted intracellularly and scattered throughout the interstitium of the infiltrate. These findings were interpreted as consistent with a reactive, non-Langerhans cell histiocytosis secondary to the patient's polyethylene knee prosthesis. This finding appears to be a local correlate of the process previously described in regional lymph nodes as reactive granular histiocytosis. Dermatopathologists should be cognizant of this uncommon reaction pattern to avoid mistaking it for a neoplastic process.

Anthrax vaccine–induced nodules

“…A similar phenomenon of collections of granular macrophages can be seen when looking at failed metal-metal grafts. 10 In a case reported by Miller et al, 10 a reactive histiocytic infiltrate was noted incidentally on a lymph node biopsy from a patient with a history of joint arthroplasty, which demonstrated CD68 + and PAS + abundant cytoplasmic granules with minute particles of polarizable intracellular material. Cobalt-chromium and titanium were found with SEM/EDX.…”

“…The rendered diagnosis was non-Langerhans cell histiocytosis secondary to knee prosthesis. 10 Distinct injection site granulomas can develop in response to aluminum within different vaccines. Since the diverse mimics of this reaction pattern can include panniculitis, lupus profundus, lymphocytoma cutis, and deep granuloma annulare/ rheumatoid nodule, it should be kept in every dermatologist's differential diagnosis when lesions occur within anatomic locations prone to receiving vaccinations, such as the deltoid or buttocks.…”

Pathological analysis of periprosthetic soft tissue and modes of failure in revision total joint arthroplasty patients

“…2 With these modes of failure, there is an associated soft tissue response adjacent to the implants that may occur to a significant degree resulting in an unfavorable surgical outcome. 3,4 In the past, microscopic analysis of the soft tissue response in patients with implant wear and/or aseptic component loosening has revealed a proliferative infiltration of macrophages with a foreign body reaction. 3,[5][6][7][8][9][10][11][12][13][14] Many times, these modes of failure lead to revision of the artificial joint.…”

Skin Biopsy Diagnosis of Langerhans Cell Neoplasms

“…Likewise, reactive histiocytosis in the skin can be seen secondary to foreign body reactions to implants and polarizable material is often identified [21]. LC can also mimic dermal histiocytes found in inflammatory and infectious conditions (mycobacteria, fungal and parasitic processes), thus clinicopathologic correlation, immunostains and appropriate special stain can be helpful in the differential.…”