Toluidine Blue Positive Large Cells with Abundant Cytoplasm! - USMLE Forums
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Old 06-26-2012
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Skin Toluidine Blue Positive Large Cells with Abundant Cytoplasm!

A 9-year-old girl is brought to the physician by her parents because she has been scratching a group of small bumps on the skin of her forearm for the past month. On physical examination, there are five 0.4- to 0.9-cm, small, flat to slightly papular, pale brown lesions on the volar surface. The lesions become more pruritic with swelling and erythema when rubbed. A biopsy specimen of one of the lesions examined microscopically shows an upper dermal infiltrate of large cells with abundant pink cytoplasm that stains an intense purple color with toluidine blue. Which of the following cell types is most likely to form these lesions?
(A) CD4+ lymphocyte
(B) CD8+ lymphocyte
(C) Langerhans cell
(D) Macrophage
(E) Mast cell
(F) Melanocyte
(G) Merkel cell
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Old 06-26-2012
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Hi
I think the answer is E mast cell.
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Old 06-26-2012
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Not sure about the toluidine stain but from the vignette, it seems like urticaria pigmentosum. I'd go with mast cells too.

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Old 06-26-2012
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Quote:
Originally Posted by smanthrav View Post
Not sure about the toluidine stain but from the vignette, it seems like urticaria pigmentosum. I'd go with mast cells too.

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Hi Toludine blue is as stain that is used to stain mast cells, mast cell exhibit metachromasia, so although the dye is blue , they stain purple.

I will go with mast cells aswell
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Old 06-26-2012
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Answer is e
mast cell disorders:
Localized-urticaria pigmentosum, solitary mastocytoma
systemic-systemic mastocytosis
signs and symptoms relate to mast cell release of histamine
pruritus and swelling of tissue
urticaria pigmentosum -multiple oval, red-brown nonscaling macules or papules. scratching results in erythematous swelling of the lesions and pruritus -called darier's sign. dermatographism-dermal edema occurs when apparently normal skin is stroked with a pointed object. lessions remain hyperpigmented when they regress. skin biopsy -mast cells have metachromatic granules, granules stain positive with toluidine blue and giemsa stain. pruritus and flushing may be triggered by foods alcohol drugs
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