CD8+ Lymphomatoid Papulosis in a Patient with Simulataneous Type A, Type B, and Type C Lesions

Abstract

Lymphomatoid papulosis (LyP) is a cutaneous CD30+ lymphoproliferative disorder characterized by recurrent papulonecrotic or papulonodular lesions with histologic features of a malignant lymphoma and an excellent prognosis. Three morphologic types (A, B, and C) of LyP exist and typically display an immunophenotype of CD4+, CD8−, and CD30+. We present a case of a 63‐year‐old woman with a one‐year history of relapsing papulonecrotic skin eruptions. Biopsy of a lesion on the forearm showed a superficial and deep dermal wedge‐shaped infiltrate with large lymphoid cells (Type A LyP). A lesion on the abdomen showed a band‐like superficial dermal infiltrate composed of small lymphoid cells with extensive epidermotropism and cerebriform nuclei (Type B LyP). Lastly, a lesion on the buttock histologically showed a dense, diffuse dermal infiltrate composed of a mixture of small and large lymphoid cells (Type C LyP). In all three lesions, the atypical lymphocytes were immunoreactive to CD8 and CD30 and nonreactive to CD4. CD8 positive cases of LyP are rare in the literature and tend to occur in pediatric patients. Moreover, while approximately 10% of patients may present with lesions of both the type A and type B types, cases showing all three types of LyP are exceedingly rare.