A double dose of pseudolymphoma: Cutaneous intravascular CD30+ pseudolymphoma arising in acral pseudolymphomatous angiokeratoma – a case report

Abstract

Cutaneous intravascular CD30+ pseudolymphoma is a rare entity with only a handful of cases reported thus far in the literature. This case study reports a patient who presented with a non-healing wound of the forearm, which on excision biopsy was found to have the histological features of an acral pseudolymphomatous angiokeratoma, also known as papular angiolymphoid hyperplasia. Distended lymphatics within the lesion were filled with a monotonous population of intermediate sized lymphocytes with distinct nucleoli and considerable associated apoptotic debris. Immunoperoxidase staining showed almost uniform staining for CD4 and around 50% staining for CD30. The occurrence of cutaneous intravascular CD30+ pseudolymphoma has previously been reported in the setting of a regressing keratoacanthoma of the cheek1 and has been associated with chronic inflammation after trauma.2 In this case the finding was interpreted as a florid reactive hyperplasia, with the recommendation for follow up and T-cell clonality studies should recurrence occur. To our knowledge, no recurrence has occurred 20 months post initial presentation. Awareness of this benign cutaneous lymphoproliferation as a reactive process is necessary in distinguishing it from malignant intravascular T-cell lymphomas.