Multinucleate Cell Angiohistiocytoma: A Case Report and Unique Treatment Consideration

Abstract

Introduction:  Multinucleate cell angiohistiocytoma (MCAH) is a benign, yet exceedingly rare vascular and firbiohistiocytic proliferation. The lesions are typically asymptomatic and are commonly cosmetically displeasing to patients. ¹ Previous reports have demonstrated success in treating MCAH with fractional ablative CO2 laser, argon laser, pulsed dye laser, and KTP lasers. ³ The scarcity of reported cases may suggest that the lesion is commonly misdiagnosed, and we report this case to highlight the characteristic features of MCAH with successful treatment with Neodymium YAG laser.

Case Presentation: A 64-year- old female presented to our clinic with a 1- month history of multiple erythematous to violaceous lesions on her bilateral hands. The lesions were asymptomatic, but cosmetically displeasing for the patient. Past medical history and family history was noncontributory. Examination revealed several 2-6 mm well- circumscribed, erythematous, indurated smooth papules on the bilateral dorsal and in the second web space of the left hand. Shave biopsy of the lesions were consistent with MCAH. She was initially treated with topical steroids twice daily for 2 weeks, with no improvement. The patient received 3 treatments with Neodymium YAG, 4 weeks apart. This treatment was discontinued after 3 sessions due to the dramatic visible improvements in regards to induration and discoloration of the lesions.

Discussion: MCAH is an extremely uncommon lesion, diagnosis is made on the basis of clinical examination, histopathologic and immunohistochemical analysis of the lesions. This case illustrates diagnosis and successful treatment of MCAH with Neodymium YAG and offers a unique treatment consideration for patients.