Mast cell Infiltration in a Patient with Cutaneous Plasmacytosis

Case Report

Austin J Dermatolog. 2014;1(3): 1012

Mast cell Infiltration in a Patient with Cutaneous Plasmacytosis

Wei Jin and Zhang Jianzhong*

Department of Dermatology, Peking University People's Hospital, China

*Corresponding author: Zhang Jianzhong, Department of Dermatology, Peking University People's Hospital, Beijing, China

Received: June 09, 2014; Accepted: July 02, 2014; Published: July 07, 2014


Plasmacytosis; Mast cell infiltration; Cutaneous

Mast cells are important effector cells of the immune system and are found in all vascularized tissue, especially in the skin and mucosa of the respiratory and gastrointestinal tracts. Mast cells release a variety of inflammatory mediators that may induce heterogeneous symptoms [1-3]. Here we report a case of cutaneous plasmacytosis with mast cell infiltration and discuss the clinicopathological features and differential diagnostic considerations.

A 41-year-old Chinese female presented with reddish brown macules and plaques on the trunk over 9 years. The lesions were slightly itchy. The patient had been diagnosed as dermatitis and urticaria pigmentosa in local hospitals. She failed to respond to antihistamines and topical corticosteroids. The patient had a 3-year history of chronic non-atrophic gastritis. She had no other remarkable past medical history.

On physical examination, multiple oval brownish macules, papules, and plaques about 1.0~2.0mm in diameter were found on the waist and other parts of the trunk. Friction on the lesion could induce wheal and flush response (positive Darier sign, figure 1A).

The complete blood count, urine analysis, total serum IgE level, serum biochemical analysis were all normal. Rheumatoid factor and antinuclear antibody were negative. Abdominal ultrasound and chest X-ray examination were normal. Immunoglobulin G (IgG) was 35.2g/L (reference: 6.94-16.68g/L), IgA 6.75g/L (0.68-3.78g/ L), β2-microglobulin (-), KAPPA light chain 3160mg/dL (629- 1350mg/dL), LAMBDA light chain 1260mg/dL (313-723mg/ dL), C-reactive protein (CRP) 43.8mg/L(<7.9mg/L), erythrocyte sedimentation rate (ESR) 93mm, Bence Jones protein (-), peripheral blood IgH gene rearrangement (-), chromosome check: 46XX [20]. Bone marrow puncture and biopsy findings revealed inactive bone marrow hyperplasia, higher ratio of plasma cells.

The histopathology of the skin biopsy showed many plasmocytes and a few mastocytes infiltrated in the superficial and middle dermis. Immunohistochemical staining showed that the infiltrates were positive for CD117, CD38, CD138, KAPPA, and LAMBDA partially(+), Ki67 (5% +), PAS staining, acid-fast staining (-). Toluidine blue staining showed small purple heterophilic granules in the cytoplasm of a few cells in the dermis (figure 1B-F). Giemsa staining of gastric biopsy (-).

Citation: Jin W and Jianzhong Z. Mast cell Infiltration in a Patient with Cutaneous Plasmacytosis. Austin J Dermatolog. 2014;1(3): 1012. ISSN:2381-9197