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To the Editor We read the letter by Foo and collaborators1 with great interest. What surprised us is not only that their enumeration of AESOP cases is wrong, but also that they failed to underline the profound differences in the histopathologic characteristics with respect to the original case of Lipsker et al.2 In fact, the number of reports of AESOP cases that have been published so far is 11 and not 9. Foo and collaborators may find the list in an article by our research group.3 The histopathologic features of their patient differ because of the absence of dermal mucin deposition, which Dr Foo and collaborators do not even mention and which is present in all other reported cases, and because of the presence of pleomorphic and multinucleated histiocytes (CD68+) and myofibroblasts, which have never been reported before. We believe that the histopathologic features of their case are not “comparable to the cases described by Lipsker et al,”1(p1431) as they assert, but are distinctive. The reasons for such differences are difficult to understand. The possibility of a plaquelike type of multinucleated angiohistiocytoma cannot be ruled out because it is suggested by the vascular proliferation and the pleomorphic and multinucleated CD68+ histiocytes.4 Alternatively, if we consider the lesion as an unusual histologic variant of skin patch in the setting of AESOP, it may be that the different nature of the underlying tumor is related to the production of a different panel of cytokines diffusing from the tumor into the tissues of the chest wall and stimulating a different cellular component, according to the concept of “contiguous inflammation of the skin.”5(p49)
Rongioletti F, Rebora A. A Variant of AESOP Syndrome (Adenopathy and Extensive Skin Patch Overlying a Plasmacytoma). JAMA Dermatol. 2013;149(9):1117-1118. doi:10.1001/jamadermatol.2013.4763