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| Year : 2012 | Volume
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| Issue : 1 | Page : 126 |
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| Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall |
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Seema Rao1, Nita Khurana1, Anup Mohta2
1 Department of Pathology, Maulana Azad Medical College, New Delhi, India
2 Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya (affiliated to Maulana Azad Medical College), Delhi, India
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| Date of Web Publication | 11-Apr-2012 |
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How to cite this article:
Rao S, Khurana N, Mohta A. Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall. Indian J Pathol Microbiol 2012;55:126 |
How to cite this URL:
Rao S, Khurana N, Mohta A. Nodular histiocytic proliferation in hernial sac: A potential diagnostic pitfall. Indian J Pathol Microbiol [serial online] 2012 [cited 2022 Jun 28];55:126. Available from: https://www.ijpmonline.org/text.asp?2012/55/1/126/94888 |
Sir,
Nodular histiocytic proliferation/hyperplasia (NHP/NHH) is an uncommon reactive histiocytic proliferative lesion. NHP has mostly been described in mesothelium-lined locations and only in few non-mesothelial sites. The lesion can be confused with a variety of reactive, inflammatory, or neoplastic conditions.
We describe the pathologic features of a case of NHP in the (inguinal) hernial sac in a 2-year-old boy. The lesion revealed nodular aggregates of histiocytes scattered within the fibrocollagenous wall of hernial sac [Figure 1]a. The constituent cells showed moderate amount of eosinophilic cytoplasm, ovoid to slightly lobulated vesicular nuclei and inconspicuous nucleoli [Figure 1]b. Mitoses were infrequent, and there was no significant cellular atypia. Moderate degree of scattered inflammatory cells was also noted. There was no definite granulomas formation or areas of necrosis. Stain for acid fast bacilli was negative. Based on histomorphology, possibility of NHP and Langerhans' cell histiocytosis was considered. On immunohistochemical (IHC) staining, cells expressed CD68 [Figure 1]c and were negative for CD1a [Figure 1]d. Thus, a final diagnosis of NHP in hernial sac wall was made. | Figure 1: (a) Fibrocollagenous wall of hernial sac revealing nodular aggregates of histiocytic cells, (H and E, ×20). (b) Collection of mildly pleomorphic histiocytes, (H and E, ×60). (c) Cells expressing CD68, (IHC, ×20). (d) Cells show negative staining for CD1a, (IHC, ×20)
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NHP is primarily an uncommon reactive histiocytic proliferative lesion which was previously referred to as Nodular Mesothelial Proliferation, but now, IHC has established the cell of origin to be histiocytic rather than mesothelial in nature. NHP has mostly been described in mesothelium-lined locations like peritoneal, pleural, and pericardial sites, [1],[2] and in few other non-mesothelial sites like endometrium and urinary bladder. [3],[4] In the literature, we have been able to find only one brief reference to this lesion presenting as a hernial nodule. [4] The lesion, however, has no therapeutic or prognostic significance and is often a chance finding as in the present case. The importance lies in the fact that the lesion can be confused with a variety of reactive, inflammatory, or neoplastic (like eosinophilic granuloma, granulosa cell tumor, chronic myeloid leukemia and carcinoma) conditions, as the histiocytes can show moderate atypia and high mitotic activity. [1],[3],[4] The purpose of this communication is to help familiarize pathologists with this lesion to prevent an erroneous diagnosis and unnecessary overtreatment.
 References | |  |
| 1. | Chikkamuniyappa S, Herrick J, Jagirdar JS. Nodular histiocytic/mesothelial hyperplasia: A potential pitfall. Ann Diagn Pathol 2004;8:115-20. 
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| 2. | Ruffolo R, Suster S. Diffuse Histiocytic Proliferation Mimicking Mesothelial Hyperplasia in Endocervicosis of the Female Pelvic Peritoneum. Int J Surg Pathol 1993;1:101-6.
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| 3. | Kim KR, Lee YH, Ro JY. Nodular Histiocytic Hyperplasia of the Endometrium. Int J Gynecol Pathol 2002;21:141-6.
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| 4. | Ordóñez NG, Ro JY, Ayala AG. Lesions described as nodular mesothelial hyperplasia are primarily composed of histiocytes. Am J Surg Pathol 1998;22:285-92.
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Correspondence Address:
Seema Rao
Department of Pathology, Maulana Azad Medical College, New Delhi - 110 002
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.94888
[Figure 1] |
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