Cutaneous Pseudolymphoma Research Articles

CD123-positive Plasmacytoid Dendritic Cells in Primary Cutaneous Marginal Zone B-cell Lymphoma

The histogenesis of primary cutaneous marginal zone B-cell lymphoma (PCMZL) has not yet been clarified. Plasma-cytoid dendritic cells (PDC) play a crucial role in the initiation of immune responses and activation of T-cells and B-cells. We analyzed the presence of PDC by immunohistochemistry in various forms of primary cutaneous B-cell lymphomas and in B-cell pseudolymphomas. Clusters of CD123+PDC were observed in all PCMZL (23 of 23 cases; 100%) and in two-thirds of cutaneous B-cell pseudolymphomas (14 of 22; 64%), but only in a minority of primary cutaneous follicle center lymphoma (4 of 31; 13%) and not in primary cutaneous diffuse large B-cell lymphoma, leg type. CD123+ PDC clusters were found in close proximity to monoclonal plasma cells and T-cells and were already present at high numbers in early lesions and initial recurrences of PCMZL. In conclusion, the detection of larger clusters of PDC in PCMZL provides a useful adjunctive diagnostic marker and suggests a pathogenetically relevant role of these cells in PCMZL. Furthermore, the occurrence of PDC could explain the high number of T-cells typically found in PCMZL. We propose considering PCMZL as a unique and potentially antigen-driven neoplasm with PDC, T-cells, and B-cells as the constitutive tumor components.

Cutaneous CD30+ pseudolymphoma: report of a case highlighting the importance of attention to basic cytomorphological details and clinico-pathological correlation

Distinction between a cutaneous lymphoma and pseudolymphoma can sometimes be exceedingly difficult. An increasing number of reactive inflammatory conditions with large numbers of CD30-positive atypical cells are being recognized. Some of these cases may be potentially misdiagnosed as a cutaneous lymphoma (CD30-positive lymphoproliferative disorder) on morphology alone. Cutaneous herpesvirus infection, particularly when developing in immunosuppressed individuals, can present as a pseudolymphoma with numerous CD30-positive blastoid cells. A careful search for viral cytopathic changes in the epidermis and adnexal epithelium, along with correlation with the overall clinical picture and appropriate ancillary investigations, may be necessary to establish a correct diagnosis.

Intradermal CD30‐positive mononuclear cells in superficial fungal infections of the skin

CD30 protein expression was initially considered a reliable marker for the identification of CD30-positive cutaneous lymphoproliferative disorders. Subsequently, CD30 expression has also been found in cutaneous pseudolymphoma and increasing numbers of cutaneous non-neoplastic inflammatory disorders. This paper describes two cases of superficial fungal infection of the skin that demonstrate prominent expression of CD30 within the dermal inflammatory infiltrates. This is the first report of CD30 expression associated with superficial cutaneous fungal infections.

Treatment of cutaneous pseudolymphoma with interferon alfa-2b

Treatment of cutaneous pseudolymphoma with interferon alfa-2b

Cutaneous pseudolymphoma: An unusual presentation of a scalp mass

The term cutaneous pseudolymphoma (CPL), an accumulation of lymphocytes in response to a foreign antigen or unknown stimuli lacks specificity, and has been used when neither cause nor mechanism for the lymphocytic proliferation has been identified. Cases of childhood CPL are rare and require extensive investigation because of their potential for malignant transformation. We report a case of a child with a scalp mass diagnosed as CPL.

Folliculite pseudolymphomateuse du visage chez un enfant : aspect hypochromique

The entity called pseudolymphomatous folliculitis (PLF) is a cutaneous pseudolymphoma. We report a new case of PLF with an atypical clinical presentation. A 6-year-old child was examined for an asymptomatic, hypochromic lesion of the face progressing for three months. The histology showed the activated pilosebaceous units with characteristic perifollicular infiltration by T-cells associated with dendritic cells expressing CD1a and protein S100. The outcome was spontaneously favourable. All of the foregoing elements supported a diagnosis of PLF. PLF is defined as a clinical-pathological entity among the cutaneous pseudolymphomas. The usual clinical aspect is that of a solitary red-to-violaceous asymptomatic nodule measuring less than 1.5cm in diameter. Histology shows follicular invasion characterized by lymphocytic infiltration into pilosebaceous units, creating architectural distortion; this infiltration is associated to perifollicular dendritic cells expressing CD1a and protein S100. We report this new case of PLF because of its peculiar clinical presentation. However, FPL remains a controversial entity, since the follicular location of the pseudolymphomatous lymphocytic infiltration seems poorly specific in facial lesions.

Pseudoclonality in cutaneous pseudolymphomas: a pitfall in interpretation of rearrangement studies

Pseudoclonality is a well-known problem in the interpretation of rearrangement studies of lymph node biopsies. Recently, pseudoclonality has been demonstrated in skin lesions of borreliosis. Studies on pseudoclonality in cutaneous pseudolymphomas are lacking but pseudoclones may pose a risk for overinterpretation of such lesions as cutaneous lymphoma. To determine the frequency of pseudoclonality in cutaneous pseudolymphomas identified by clinicopathological correlation and follow up. Study of 30 lesions of pseudolymphomatous cutaneous infiltrates (including insect bite reactions, borrelial pseudolymphomas and pseudolymphomatous drug eruptions) by histopathology, immunophenotyping, T-cell receptor gamma rearrangement and IgH rearrangement. Seven infiltrates were B-cell pseudoclonal; four were T-cell pseudoclonal. Moreover, B-cell clonality was identified in four cases. Immunophenotyping demonstrated that B-cell pseudoclonality and B-cell clonality occurred when infiltrates were moderately dense and included only a minority of B lymphocytes. T-cell pseudoclonality also occurred mostly in moderately dense infiltrates. B-cell and T-cell pseudoclones are not uncommonly encountered in moderately dense pseudolymphomatous infiltrates (23% and 13%, respectively). B-cell clonality is seen occasionally in pseudolymphomatous infiltrates (13%), especially when they are sparse in B lymphocytes. Therefore, rearrangement studies cannot be interpreted without correlation with morphological patterns and immunophenotyping of infiltrates and they need to be confirmed by duplicate or triplicate tests in order to prevent overinterpretation.

Cutaneous pseudolymphoma associated with molluscum contagiosum: a case report

We report an unusual case of molluscum contagiosum associated with pseudolymphoma in an otherwise healthy young woman. She presented with a 2‐week history of a rapidly enlarging painful umbilicated nodule behind her right ear. With the clinical presentation suspicious for a tumoral lesion, we decided to remove it surgically. Histological examination showed a florid cellular infiltrate surrounding a typical lesion of molluscum contagiosum. The infiltrate was composed of small to large pleomorphic lymphocytes. However, clonal TCR rearrangement could not be demonstrated. As far as we know this is the first case where the clinical picture is shown.

Pseudolinfoma B inducido por hidróxido de aluminio tras tratamiento hiposensibilizante

Aluminium hydroxide is used as an adjuvant in vaccines. We describe the case of a patient who presented a persistent adverse local reaction to aluminium hydroxide due to hyposensitization therapy to dust mites. Multiple painful and pruriginous subcutaneous nodules were observed in both arms, along with hypertrichosis at the injection site. Histology revealed a pseudolymphomatous B cell reaction predominantly involving cells that were CD20 positive, did not express bcl-2, and did not display the t(14-18) translocation. The cells also exhibited polyclonal rearrangement of the immunoglobulin heavy chains. X-ray spectral microanalysis revealed deposits of inorganic aluminium in the granular histiocytes among the germinal centers. The patient was diagnosed with cutaneous B-cell pseudolymphoma due to aluminium hydroxide as a result of immunotherapy.

B-Cell Pseudolymphoma Caused by Aluminium Hydroxide Following Hyposensitization Therapy

Aluminium hydroxide is used as an adjuvant in vaccines. We describe the case of a patient who presented a persistent adverse local reaction to aluminium hydroxide due to hyposensitization therapy to dust mites. Multiple painful and pruriginous subcutaneous nodules were observed in both arms, along with hypertrichosis at the injection site. Histology revealed a pseudolymphomatous B cell reaction predominantly involving cells that were CD20 positive, did not express BCL-2, and did not display the t(14;18) translocation. The cells also exhibited polyclonal rearrangement of the immunoglobulin heavy chains. X-ray spectral microanalysis revealed deposits of inorganic aluminium in the granular histiocytes among the germinal centers. The patient was diagnosed with cutaneous B-cell pseudolymphoma due to aluminium hydroxide as a result of immunotherapy.

Cutaneous B-cell Pseudolymphoma at the Site of Vaccination

Pseudolymphomas are a rare complication of vaccination, presenting with dense lymphoid infiltrates and prominent follicular pattern. We report our observations on 4 patients with vaccination-induced B-cell pseudolymphoma (all females; age range 19 to 60 years; median: 34.5 years). Clinically 3 patients presented with subcutaneous nodules and 1 presented with a large, indurated, erythematous plaque. Histology revealed in all cases dense lymphoid infiltrates in the subcutaneous fat with prominent follicular pattern. The follicles displayed features of reactive germinal centers (normal mantle zone, presence of tingible body macrophages, normal proliferation). Necrotic areas surrounded by palisaded histiocytes were seen in 3 biopsies from 2 patients. A mixed-cell infiltrate with eosinophils and plasma cells was present in all cases. In addition, histiocytes with granular basophilic cytoplasm could be observed around the focal area of necrosis or within the inflammatory infiltrate. Follow-up was available for 3 patients. One patient was alive with persistent disease 6 months after the first observation. Two patients were treated with local radiotherapy and are alive and free of disease after 12 and 72 months, respectively. One of these two patients had a second pseudolymphoma on the contralateral arm after a new injection of vaccine. Cutaneous pseudolymphoma after vaccination should be distinguished histopathologically from low-grade cutaneous B-cell lymphomas (follicle center cell lymphoma, marginal zone lymphoma) and from other B-cell pseudolymphomas with prominent follicular pattern requiring different treatment (eg, Borrelia burgdorferi-induced lymphocytoma cutis).

Composite Lymphoma: A Late Relapsing Primary Cutaneous B Cell Lymphoma Coexisting with Nodal Hodgkin's Lymphoma.

The simultaneous manifestation of different lymphomas in the same patient or in the same tissue is defined composite lymphoma. Although reports of synchronous or metachronous Hodgkin's lymphoma (HL) and Non Hodgkin's lymphoma (NHL) are not uncommon in the literature, the biologic relationship of the 2 malignancies is often unclear. Primary cutaneous B-cell lymphomas (pCBCLs) have been recognized as distinct clinicopathologic entities; they represent a wide spectrum of lymphoproliferative disorders separated from of B-cell NHL secondarily involving the skin and cutaneous B-cell pseudolymphomas. As regarding pCBCLs, a concomitant diagnosis of HL has been described very rarely. This is the case of a caucasian man affected by primary cutaneous follicolar B cell lymphoma (pCFCL). He presented grouped red plaques located on the nape, abdomen, shoulders, arms and even some little tumors surrounded by erythematous papules. Complete staging procedures did show no evidence of extracutaneous disease. A subcutaneous interferon therapy was started, in some months the patient reached a complete remission, and a maintainance therapy was continued for about 2 years. After 15 years, at the age of 58, the patient presented a red to violaceous infiltrated solitary plaque on the back, appeared about 2 months before. The lesion was completely excised and the biopsy showed a diffuse dermal infiltrate, not involving the epidermis, structured in follicle with reactive germinal centers; they were surrounded by small sized monomorphic lymphocytes with irregular nuclei and pale cytoplasm, showing the following immunophenotype pattern: CD20+, CD3−, IRTA+, CD10−, BCL6−, BCL2+, low proliferative index. A plasmacellullar CD138+ and CD79a+ population was at the periphery of the infiltrates, with monotypic expression of cytoplasmic k chain. The whole picture was interpreted as primary cutaneous marginal zone B-cell lymphoma (pCMZL). The association with Borrelia burgdorferi infection, sometimes described in pCMZL, wasn't demonstrated. The patient presented a large right axillary lymph node that was excised and found to be unexpectly infiltrated by HL, mixed cellularity subtype. The patient underwent a standard baseline staging procedure with total body CT scan and bone marrow trephine biopsy; the latter resulted negative; the t(11;14) and t(14;18) rearrangements weren't demonstrated in bone marrow; the CT did show no other suspected masses nor lymphoadenopathy, besides the clinically evident right axillary lymph node. A 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed sites of hyperactivity in the same right axillary region, but extending to the subclavian region and the thoracic region. The patient started chemoterapy (ABVD regimen), and at the end of 4 courses a whole body CT scan and FDG-PET resulted both negative. Now he is being treated with radiotherapy. If the nodal malignancy would have been diagnosed first, the skin lesion probably could have been misinterpreted as a secondary localization of HL; if the node biopsy wouldn't have been performed we could diagnose B-cell NHL secondarily involving the skin (stage IV). Nevertheless the cutaneous and nodal infiltrates had a completely different general picture and phenotype. This case probably reflects a HL after 15-year remission of a pCBCL of low grade and the relationship between HL and the preceding pCFCL is not clear: casual or related to genetic predisposition for oncogenic events or favoured by an immunodeficiency state related to the first disease and the previous immunomodulatory therapy.

Cutaneous pseudolymphoma in association with Leishmania donovani

British Journal of DermatologyVolume 157, Issue 5 p. 1042-1043 Cutaneous pseudolymphoma in association with Leishmania donovani M.J. Flaig, M.J. Flaig Department of Dermatology, Ludwig Maximilians University Munich, Frauenlobstrasse 9–11, 80337 Munich, GermanyE-mail: mflaig@med.uni-muenchen.deSearch for more papers by this authorR.A. Rupec, R.A. Rupec Department of Dermatology, Ludwig Maximilians University Munich, Frauenlobstrasse 9–11, 80337 Munich, GermanyE-mail: mflaig@med.uni-muenchen.deSearch for more papers by this author M.J. Flaig, M.J. Flaig Department of Dermatology, Ludwig Maximilians University Munich, Frauenlobstrasse 9–11, 80337 Munich, GermanyE-mail: mflaig@med.uni-muenchen.deSearch for more papers by this authorR.A. Rupec, R.A. Rupec Department of Dermatology, Ludwig Maximilians University Munich, Frauenlobstrasse 9–11, 80337 Munich, GermanyE-mail: mflaig@med.uni-muenchen.deSearch for more papers by this author First published: 21 August 2007 https://doi.org/10.1111/j.1365-2133.2007.08129.xCitations: 16 Conflicts of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume157, Issue5November 2007Pages 1042-1043 RelatedInformation

Postzoster cutaneous pseudolymphoma in a patient with B‐cell chronic lymphocytic leukaemia

Postzoster cutaneous pseudolymphoma in a patient with B‐cell chronic lymphocytic leukaemia

Pseudolymphomatous Cutaneous Angiosarcoma: A Rare Variant of Cutaneous Angiosarcoma Readily Mistaken for Cutaneous Lymphoma

Cutaneous angiosarcoma is probably the most malignant neoplasm involving the skin. Three clinical variants of cutaneous angiosarcoma are recognized, including angiosarcoma of the scalp and face of elderly patients, angiosarcoma associated with chronic lymphedema, and postirradiation angiosarcoma. Histopathologically, these three variants of angiosarcoma show similar features, which consist of poorly circumscribed, irregularly dilated, and anastomosing vascular channels lined by prominent endothelial cells that dissect through the dermis. Focally, neoplastic endothelial cells show large, hyperchromatic, and pleomorphic nuclei, protruding within vascular lumina and creating small papillations. Usually, inflammatory infiltrate is sparse and consists of a patchy, perivascular lymphoid infiltrate around the neoformed vessels. In rare instances, cutaneous angiosarcomas may exhibit prominent inflammatory infiltrate, and the neoplasm may be mistaken for an inflammatory process, both from clinical and histopathologic points of view. We describe four examples of cutaneous angiosarcomas with dense lymphocytic infiltrates involving the neoplasm. Immunohistochemically, lymphocytes expressed immunoreactivity for CD3, CD5, and CD45 markers, whereas the germinal centers were positive for CD20, CD79a, and Bcl-6. The neoplastic endothelial cells expressed immunoreactivity for the CD31, CD34, podoplanin, Prox-1, Lyve-1, and D2-40. We discuss the possible relationship between neoplastic endothelial lymphatic cells and reactive lymphocytes. Cutaneous angiosarcoma with prominent lymphocytic infiltrate may be readily mistaken for cutaneous follicle center cell lymphoma or cutaneous pseudolymphoma.

Drug-Associated Lymphoma and Pseudolymphoma: Recognition and Management

This article discusses ways to recognize and manage lymphomas and pseudolymphomas associated with drug exposure. Over the last 30 years, the classification of pseudolymphomas and lymphomas has undergone significant change, especially following the application of sophisticated immunostaining and gene rearrangement analysis. The term cutaneous pseudolymphomas (CPL) is a nonspecific term for a heterogeneous group of benign reactive T- or B-cell lymphoproliferative processes that simulate cutaneous lymphomas clinically or histologically. While pseudolymphomas are relatively rare diseases, their clinical and histological heterogeneity has led to multiple systems of categorization based on immunological factors, causative agents, presentation, and clinical course.

Cutaneous pseudolymphoma arising after tattoo placement

Cutaneous pseudolymphoma arising after tattoo placement

Cutaneous Pseudolymphoma Following Administration of Lornoxicam

Since aspirin was introduced over a century ago, many new anti-inflammatory agents have been marketed. NSAIDs are currently the most commonly prescribed agents in Western medicine (1). Their widespread use has resulted in a number of well-documented adverse reactions. These most frequently involve the gastro-intestinal tract, causing discomfort, nausea and diarrhoea or, occasionally, bleeding and ulceration (2). Cutaneous reactions mainly include urticaria, angioedema, fixed drug eruption, pruritus, photosensitivity and, in severe cases, Stevens-Johnson syndrome and toxic epidermal necrolysis (3). Lornoxicam (chlortenoxicam) is a new selective cyclooxygenase-2 (COX-2) inhibitor of the oxicam class, with analgesic, anti-inflammatory and antipyretic properties (4). Lornoxicam has a tolerability profile characteristic of an NSAID. No pseudolymphomatous reaction has been reported before. CASE REPORT

Cutaneous pseudolymphomas: a diagnostic challenge requiring clinical, histological, immunological and molecular analysis

Cutaneous pseudolymphomas (CPLs) are a group of benign lymphoproliferative conditions of the skin that histologically and, occasionally clinically, resemble malignant cutaneous lymphomas. CPLs may resemble cutaneous T-cell lymphomas or cutaneous B-cell lymphomas. The differentiation between benign and malignant lymphoproliferations can be challenging and requires a combination of clinical, histological, immunohistological and molecular analysis for accurate diagnosis. On rare occasions, absolute differentiation may not be possible. In this review, we discuss the histological techniques used in the evaluation of lymphoproliferations.

Primary Cutaneous Lymphoproliferative Disorders With Dual Lineage Rearrangement

We present a series of 15 cases of cutaneous lymphoma and pseudolymphoma with dual lineage rearrangement identified among approximately 1200 cases of cutaneous lymphoproliferative disorders assessed in our 4 institutions during the last 8 years in which the results of both T-cell receptor and immunoglobulin heavy chain rearrangement investigations were available. On the basis of the clinicopathologic information, the cases were retrospectively subdivided into 2 categories: (1) cases with definite features of cutaneous lymphoma or pseudolymphoma (n = 11) and (2) cases with unclassifiable disease (n = 4). The detection of dual genotype in the first group did not influence the final diagnosis; 7 cases represented cutaneous B-cell lymphomas, 3 pseudolymphomas, and 1 case lymphomatoid papulosis. The presence of monoclonal T-cell receptor-gene rearrangements in these cases may be explained either by monoclonal or oligoclonal expansion of exuberant T cells (or B cells in case of lymphomatoid papulosis) or by lineage infidelity. Three patients with unclassifiable disease had several clinical and histopathologic features in common. They were elderly, presented with solitary lesions, were in good general health and histopathologically demonstrated a dense multinodular infiltrate containing approximately an equal number of T and B cells and a high number of histiocytes forming granulomas, with prominent granulomatous features in 2 cases. B cells were either scattered with the infiltrate or formed collections vaguely resembling follicles; Reed-Sternberg-like cells were seen in 2 cases. B cells showed expression neither of immunoglobulin light chain. The T-cell component was represented mainly by small, well-differentiated lymphocytes or slightly pleomorphic cells, with some medium-sized convoluted cells. Epstein-Barr virus was not detected by polymerase chain reaction. The exact classification of these cases is unknown; they differ histopathologically from previously published cases of bigenotypic cutaneous lymphomas. They may merely represent a growth or reactive pattern, but, on the other hand, may be low-grade lymphomas. If so, they may be histopathologically related to cutaneous Hodgkin disease, T-cell/histiocyte-rich large B-cell lymphoma, or composite lymphomas. Further reports are needed to identify these lesions to clarify their nature and biologic potential.