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February 1997

Asymptomatic Nodules on the Chest

Author Affiliations

New York Hospital—Cornell Medical Center, New York

Arch Dermatol. 1997;133(2):236. doi:10.1001/archderm.1997.03890380109020

REPORT OF A CASE  A 16-year-old African American girl presented with several asymptomatic cutaneous lesions on her chest that she said arose within chickenpox scars. Examination revealed several dome-shaped, firm, flesh-colored papules and nodules ranging from 4 to 10 mm in diameter. The overlying epidermis was intact without crusting or scale (Figure 1). The remainder of the skin examination showed scattered varicella scars. The results of laboratory investigations, including a complete blood cell count, erythrocyte sedimentation rate, immunologic studies, and serum protein electrophoresis, were unremarkable. A chest x-ray film and an abdominal computed tomogram were normal. A biopsy specimen was obtained for routine histopathological evaluation (Figure 2 and Figure 3). S100 protein immunolabeling is illustrated in Figure 4.What is your diagnosis?

DIAGNOSIS:  Cutaneous sinus histiocytosis (CSH) (cutaneous Rosai-Dorfman disease).Sinus histiocytosis with massive lymphadenopathy (SHML) was first described by Rosai and Dorfman1 in 1969. In its usual clinical presentation, this distinct entity is characterized by marked enlargement of the lymph nodes, especially those

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