To the Editor.—
I read the article by Peter V. Pickens, MD, and Marc Rosenshein, MD (1981;246:1810). I question their interpretation that the process involving the pericardial space represents infiltration by histiocytosis X cells. Do they have ultrastructural confirmation (which was deleted) that these histiocytic cells contained Langerhans' granules? Langerhans' granules are cytoplasmic organelles observed ultrastructurally, which are present in the neoplastic cells (Langerhans' cells) in histiocytosis X.1 They are rarely encountered in other diseases. From the published photograph (Fig 2), the cells are entirely consistent with mesothelial cells that are present in pericardial fluid. Mesothelial cells can mimic Langerhans' cells (vesicular nucleus with grooves and abundant acidophilic cytoplasm).2 The article that they referenced as two cases with pleural involvement is likewise not well documented.3I appreciate the clinical possibility that the patient might have pericardial involvement; however, to emphasize I quote from a current surgical pathology
Pittman DL. Histiocytosis X With Pericardial Effusion: Diagnosis Questioned. JAMA. 1982;247(19):2660–2661. doi:10.1001/jama.1982.03320440012013
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