Histiocytosis X With Pericardial Effusion: Diagnosis Questioned

To the Editor.— The patient described in the case report by Peter V. Pickens, MD, and Marc Rosenshein, MD (1981; 246:1810), was initially seen at the University of Illinois, Abraham Lincoln School of Medicine and at Mercy Hospital and Medical Center, Chicago. Biopsy specimens of her skin lesions and submaxillary salivary glands showed changes diagnostic of multicentric reticulohistiocytosis and not histiocytosis X as reported. These were the only biopsy procedures performed on this patient. The illustrations in the article by Drs Pickens and Rosenshein do not demonstrate the findings described in their legends. Figure 1 (p 1810) shows a sebaceous unit made up of cells with clear, foamy cytoplasm rather than "mature histiocytic cells with abundant eosinophilic cytoplasm." Figure 2 (p 1810) resembles a mesothelial lining filled with plasma cells and inflammatory mononuclear cells. Our examination of the skin specimen by routine light microscopy showed that the dermis was infiltrated