Lymphocytic Infiltration Of Skin Research Articles

Disseminated Lymphocytoma Cutis in a Patient with B-cell Non-Hodgkin’s Lymphoma

Lymphocytoma cutis (LC) is one of the pseudolymphomas. It clinically and histopathologically resembles to cutaneous lymphomas due to the accumulation of lymphocytes. LC can be solitary characterized by only one nodule or disseminated, presenting as extensive lesions. It presents with soft and doughy or firm nodules, skin color, reddish brown, or reddish purple mainly on exposed area, such as the face. It has to be differentiated from Jessner’s lymphocytic infiltrate of skin by histopathological and immunohistochemical examinations. Apart from treatment, follow-up of patients is crucial, as the condition can evolve into cutaneous lymphoma. We present a case of 54-year-old male, with lesions over the face, trunk, and both extremities diagnosed with disseminated LC.

Anti-HMGCR myopathy: clinical and histopathological features, and prognosis.

This review aims to describe clinical and pathological features, prognosis and treatment in patients with anti-HMGCR antibody positive immune-mediated necrotizing myopathy (HMGCR-IMNM) based on recent findings. Using advances in diagnostic modalities that can confirm the presence of anti-HMGCR antibody, the clinical and pathological manifestations of HMGCR-IMNM were found to be broader than previously reported. Although only a small percentage of HMGCR-IMNM patients present with atypical manifestations, some of these patients show slow disease progression and clinical symptoms, which are similar to those of limb-girdle muscular dystrophies. Other atypical HMGCR-IMNM patients have skin conditions similar to dermatomyositis-like skin rush or dermatological presentations of Jessner-Kanoff disease or cutaneous lymphoma, whose pathological changes including CD8-positive and bcl-2-positive lymphocytic accumulations, similar to Jessner-Kanoff lymphocytic infiltration of skin or low-grade cutaneous lymphoma, which are observed in muscle and skin. Anti-HMGCR autoantibodies define unique populations of IMNM patients. Recent studies have revealed that clinicopathological manifestations of HMGCR-IMNM, especially extramuscular symptoms and pathological manifestations, are more common than previously recognized.

Pathomorphological changes in patients with Jessner>s lymphocytic infiltrate of skin, reticular erythematous mucinosis and lupus tumidus

Pathomorphological changes in patients with Jessner>s lymphocytic infiltrate of skin, reticular erythematous mucinosis and lupus tumidus

Pathomorphological changes in patients with Jessner>s lymphocytic infiltrate of skin, reticular erythematous mucinosis and lupus tumidus

Jessner’s lymphocytic infiltrate of skin, reticular erythematous mucinosis and lupus tumidus are the group of rare, insufficiently explored dermatosis with common clinical and histological features, whose nosology is controversial today. Plasmacytoid dendritic cells play the key role in autoimmune disease induction The target of our study was the analysis of pathomorphological features of lesional skin and the research of plasmacytoid dendritic cells in the skin of patients with Jessner’s lymphocytic infiltrate of skin, reticular erythematous mucinosis and lupus tumidus. Material and methods. Histological and indirect immunohistochemistry examination (anti-CD123 antibodies) of lesional skin of 36 patients was held (JLIS - 12, REM - 10, LT - 14) and 10 healthy people. Result. The main pathomorphological changes of skin in all groups were found in dermis: dense perivascular and perifollicular infiltration and deposit of mucin between collagen fibers. Deposits of mucin in papillary dermis were found between patients with JLIS, REM and LT in 10/12 (83%), 7/10 (70%) and 12/14 (86%) of cases, there were no mucin found in skin of healthy people 0/10 (0%) In all dermatosis the distribution of CD123 cells in lesional skin, in immunohistochemistry study, was corresponded clusters model of infiltrate - plasmacytoid DC concentrate in groups around vessels of superficial and profundus networks and perivascular. The comparative analysis of density and localization of perivascular infiltration, number of CD123-cells and their correspondence in dermis perivascular infiltrates didn’t reveal statistically significant differences between JLIS, REM and LT. Results. Our results allow us to consider JLIS and LT as identical decease, and REM as similar in clinical-pathomorphological features dermatosis.

English

Jessners lymphocytic infiltration of the skin is a chronic, benign T-cell infiltrative disorder, usually manifesting as erythematous papules or plaques on the face, neck and back. we report the case of a 66- year - old man, who presented with erythematous papules and plaques on nose of 4 months duration and erythematous plaque on right arm of 1 month duration. skin biopsy confirmed the diagnosis of jessner's lymphocytic infiltration of the skin.The evolution was favorable with hydroxy chloroquine and prednisolone. INTRODUCTION: Jessner's lymphocytic infiltration of the skin (JLIS) is a skin condition of unknown aetiology characterized by erythematous papules and plaques located on the head, neck and upper back. The eruption resolves spontaneously after months or a few years but can recur for several years. A variety of empirical treatments has been tried with limited success. Here we report a case of jessners lymphocytic infiltration of skin successfully treated with hydroxychloroquine and prednisolone.

Granulomatous Eccrinotropic Lymphomatoid Papulosis

We describe 9 patients with a novel variant of lymphomatoid papulosis characterized by prominent localization of the infiltrate around the eccrine coil, resulting in nodular expansion of the coil accompanied by variable granulomatous inflammation. Light microscopy, immunohistochemical analysis using antibodies to CD2, CD3, CD4, CD5, CD7, CD8, and CD30 in 6 cases, and polymerase chain reaction–singlestranded conformational polymorphism analysis for Tcell receptor γ chain gene rearrangement in 5 cases revealed 2 cytomorphologic patterns (large cell dominant with polymorphous inflammation, small cell lymphocyte-rich with an inconspicuous large cell component [phenotypes, CD30+/CD3+/CD4+/CD7– for large atypical cells; reactive for small lymphocytes]) and clonal restriction in 4 and polyclonality in 1 of the lymphocyte-dominant cases. During an average 6-year follow-up, no lymphomas developed. Recognition of this variant is important— accentuation of the infiltrate around the eccrine coil and cutaneous nerves, presence of granulomatous inflammation, dominance of small lymphocytes in the dermis, and variable extension into the panniculus may lead to diagnostic confusion with entities such as discoid lupus erythematosus, Jessner lymphocytic infiltrate of skin, subcutaneous T-cell lymphoma, and persistent arthropod bite reaction. Our findings suggest that pruritus, a younger age at diagnosis, and a more indolent course are defining clinical features. The prototypic lymphoproliferative disorders that express the activation marker Ki-1 (CD30) are Hodgkin disease (HD), 1 anaplastic large cell lymphoma (ALCL), 2-4 lymphomatoid papulosis (LyP), 5,6 and rare cases of large cell B- or T-cell lymphoma. The distinctive manifestation of LyP is a chronic, self-limited dermatosis comprising recurrent “crops” of ulcerative nodules and papules resolving within 3 to 6 weeks, the histologic features of which comprise an atypical lymphocytic infiltrate mimicking malignant lymphoma. Roughly 10% of LyP cases manifest the subsequent or concurrent emergence of cutaneous T-cell lymphoma, HD, or ALCL. 7-9 In some cases, molecular studies suggest an evolution of lesions of LyP into mycosis fungoides (MF) or primary cutaneous CD30+ ALCL rather than the secondary lymphoma being a genomically independent event.

Clinical and immunologic studies in reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin

Little is understood about reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin. Our purpose was to define reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin further with focus on immunologic studies. In patients with reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin, we measured circulating immune complexes before, during, and after therapy. We examined natural killer cells in a functional assay; we performed direct immunofluorescence and T- and B-cell marker studies in skin biopsy specimens. The infiltrate in reticular erythematous mucinosis is composed of helper T cells. Circulating immune complexes are increased in both reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin and decrease with hydroxychloroquine therapy and clinical clearing. Natural killer cell function is decreased in reticular erythematous mucinosis and Jessner's lymphocytic infiltrate of skin. Changes in circulating immune complex titers accompanying therapy with hydroxychloroquine and clinical clearing, with recurrence of the condition and increase in circulating immune complexes on discontinuation of treatment, point to a possible relation between these events.

Effects of lnterferon-Alpha-2b on the Clinical Course, Inflammatory Skin Infiltrates and Peripheral Blood Lymphocytes in Patients with Severe Atopic Eczema

Increased serum IgE and enhanced susceptibility to viral infections, decreased levels of interferons, lymphocytic skin infiltrates and IgE-bearing epidermal Langerhans cells are striking features in patients with atopic eczema (AE). Since the hyper-IgE syndrome is known to improve under alpha-interferon (alpha-IFN) therapy, we treated 7 patients with severe AE and high serum IgE exclusively with 3 x 10(6) units IFN alpha 2b thrice weekly for 3 months. Before treatment the skin infiltrates mainly consisted of CD3+/CD4+/TcR alpha/beta + lymphocytes, whereas the CD3+/CD8+ phenotype was limited to about 10% of cells. After 6 weeks of therapy, epidermal inflammation with CD4+ and CD8+ cells was reduced but dense infiltrates remained in papillary perivascular areas. Expression of TcR gamma/delta, HLA-DR and CD25 showed no significant changes. Initially high serum IgE and soluble CD23 as well as cell-bound IgE dropped under therapy, whereas a short-term elevation in serum IL-2 receptor was observed. On peripheral blood lymphocytes slightly reduced expression of HLA-DR, LFA-1, CD23 and ICAM-1 was seen after 100 days. LFA-3 expression became reduced in 4 patients, the CD4/CD8 ratio decreased in all cases. After an initial therapeutic response of all patients, significant longer-lasting improvement of the skin lesions could only be observed in 2 of 7 patients. The data of our long-term study suggest that systemic IFN alpha 2b treatment leads to a remarkable reduction in epidermal inflammation but does not significantly influence cutaneous cell subsets. Immunomodulatory effects became obvious by reduced peripheral cell subsets expressing TcR alpha/beta, MHC class II and adhesion molecules.

Peripheral neuropathy in the eosinophilia‐myalgia syndrome associated with l‐tryptophan ingestion

Eosinophilia, brawny induration, and tenderness of the skin and deeper tissues, and eosinophilic and lymphocytic infiltration of skin, deep fascia, and muscle characterize the acute eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan. Many patients have a florid inflammatory myopathy. We evaluated 10 patients with this syndrome in whom peripheral neuropathy was a prominent or the only presenting feature. Two of these patients with severe neuromuscular disease required mechanical ventilation, and 1 died. Clinical severity appeared to be positively associated with the total dose of L-tryptophan ingested. Although the inflammation is generally thought to be more severe in skin, fascia, and muscle, inflammation, especially in the epineurium of sural nerve, was sometimes striking and often accompanied by vasculopathy and angioneogenesis. These cases draw attention to a new preventable syndrome with peripheral nerve involvement, emphasize the value of tissue biopsy for its diagnosis, and raise issues related to pathogenesis.

Plasmacytoid T cells in a case of lymphocytic infiltration of skin. A component of the skin-associated lymphoid tissue?

A case of cutaneous lymphocytic infiltration with large numbers of plasmacytoid T cells (PTC) is reported. Lectin staining and immunohistological analysis revealed that PTC and cutaneous dendritic cells showed a similar expression of concanavalin A, LN2, and MT1. Moreover, differences in TAL 1B5 and S-100 expression were noted. From these findings we suggest that PTC may occur in the skin as a component of the skin-associated lymphoid tissue.

An Ultrastructural Morphometric and Immunohistochemical Analysis of Cutaneous Lymphomas and Benign Lymphocytic Infiltrates of Skin

Our combined ultrastructural, immunohistochemical, histologic, and clinical studies over the past five years have allowed us to compile diagnostic criteria useful in the evaluation of cutaneous lymphomas. As a group, mycosis fungoides (MF) patients could be distinguished from those with benign disorders of skin using ultrastructural morphometry (mean form factor and perimeter values), but with some overlap between groups. Another approach, the ultrastructural histogram method, however, clearly separated MF patients from patients with chronic dermatitis. Immunohistochemistry was useful in distinguishing cases of cutaneous peripheral T-cell lymphoma from MF cases on the basis of the occurrence of "novel phenotypes." Neoplastic T-cell infiltrates of skin can usually be distinguished from benign polyclonal T-cell infiltrates by the presence of one T-cell subset to the exclusion of others. Patients with convoluted B-cell lymphomas could also be distinguished from MF patients using ultrastructural morphometric dual parameter analysis. The diagnostic complexity of several cutaneous T-cell lymphoma cases is illustrated. We have emphasized in this study the strength of combining quantitative electron microscopy, immunohistochemistry, and histology in the diagnostic workup of cutaneous lymphomas. This integrative approach may be necessary to assure a definitive diagnosis in difficult cases.

An ultrastructural morphometric and immunohistochemical analysis of cutaneous lymphomas and benign lymphocytic infiltrates of skin. Useful criteria for diagnosis

• Our combined ultrastructural, immunohistochemical, histologic, and clinical studies over the past five years have allowed us to compile diagnostic criteria useful in the evaluation of cutaneous lymphomas. As a group, mycosis fungoides (MF) patients could be distinguished from those with benign disorders of skin using ultrastructural morphometry (mean form factor and perimeter values), but with some overlap between groups. Another approach, the ultrastructural histogram method, however, clearly separated MF patients from patients with chronic dermatitis. Immunohistochemistry was useful in distinguishing cases of cutaneous peripheral T-cell lymphoma from MF cases on the basis of the occurrence of "novel phenotypes." Neoplastic T-cell infiltrates of skin can usually be distinguished from benign polyclonal T-cell infiltrates by the presence of one T-cell subset to the exclusion of others. Patients with convoluted B-cell lymphomas could also be distinguished from MF patients using ultrastructural morphometric dual parameter analysis. The diagnostic complexity of several cutaneous T-cell lymphoma cases is illustrated. We have emphasized in this study the strength of combining quantitative electron microscopy, immunohistochemistry, and histology in the diagnostic workup of cutaneous lymphomas. This integrative approach may be necessary to assure a definitive diagnosis in difficult cases. (<i>Arch Dermatol</i>1986;122:1139-1154)

Single cell DNA measurements in benign cutaneous lymphoid infiltrates and in positive patch tests.

Cellular DNA in skin biopsies from eighteen patients with positive patch tests and eleven patients with benign lymphocytic skin infiltates (cutaneous lymphocytoma, lymphoplasia or Jessner's lymphotic infiltrate) was estimated by flow cytometry of propidium iodide-stained dermal cells. Specimens from three patients with patch tests and one with cutaneous lymphocytoma had DNA histograms similar to those of normal blood mononuclear cells. The remaining patients demonstrated DNA histogram abnormalities in the form of hyperdiploid peaks in forty-two of forty-five specimens. The estimated proportion of cells in the S-phase was similar in patch tests (median: 9.2%) and in benign lymphocytic skin infiltrates (median: 9.6%). The median number of cells in the G2/M-phase was 3.1% in both groups of disorders. These data indicate DNA content heterogeneity of the dermal cells in benign lymphocytic skin infiltrates. This may be attributed to DNA replication and/or chromatin dispersion during cellular activation and proliferation. The data also emphasize that hyperdiploid peaks are not necessarily indicative of the presence of separate cell clones.

Serial observations and definition of mononuclear cell infiltrates in avian scleroderma, an inherited fibrotic disease of chickens.

University of California, Davis (UCD) line 200 chickens develop an inherited connective tissue disease which includes fibrosis, vascular occlusion, and lymphocytic infiltration of skin, comb, and viscera. To further identify the nature of these features, tissue from both affected and control chickens, aged 7 days to 12 months, was serially examined using hematoxylin-eosin and Masson's trichrome stain. Mononuclear cell accumulations in skin were simultaneously characterized using mouse anti-chicken T and B cell specific monoclonal antibodies in a solid-phase immunoperoxidase assay; the same cells were also examined by direct immunofluorescence with fluoresceinated anti-chicken IgM and IgG, and stained for esterase and acid phosphatase. At 6 weeks of age, the majority of line 200 chicks manifested dermal fibrosis, cellular infiltrates, and vessel anomalies. In contrast, visceral involvement did not reach maximum incidence until 5 months of age with involvement of small intestine (60%), lungs (60%), and kidneys (65%), and not until 1 year for esophagus (64%), heart (30%), and testes (66%). Moreover, and of particular interest, was the threefold increment of full-thickness skin biopsies in line 200 birds. The cellular infiltrates in skin, found in 100% of affected line 200 chickens, were positive for B1, a mature B cell marker found on peripheral blood and bursal B cells; the majority of these same cells were found to bear surface IgM but not IgG. These data suggest that this syndrome may result from an alteration in collagen metabolism associated with a mature subpopulation of B lymphocytes.

Histologic identification of malignant lymphoma cutis.

Sections of 47 skin biopsies diagnosed during 1960-1970 as suggestive of or diagnostic of malignant lymphoma were retrospectively analyzed. Thirteen with monomorphous cutaneous infiltrates of reticulum cells or poorly differentiated lymphocytes were encountered; all were from patients who had extracutaneous manifestations of reticulum-cell sarcoma, poorly differentiated lymphosarcoma, or leukemia at the time of biopsy or within a year after biopsy. Diagnosis of well-differentiated lymphosarcoma or leukemia cutis is more tenuous, since mature lymphocytic infiltrates were encountered in patients with or without evidence of extracutaneous lymphoma. These are designated "unclassified" lymphocytic infiltrates of skin, requiring careful clinical exclusion of these types of malignant lymphoma. Other purported histopathologic discriminants of malignant lymphoma and pseudolymphoma, the latter term utilized to designate banal disorders characterized by a polymorphous infiltrate with or without atypical reticulum cells, are of little value for their distinction. These diagnostic criteria for malignant lymphoma cutis should clarify much of the pathologic and clinical uncertainty attendant upon the so-called "lymphoreticular" infiltrates of the skin.

Lymphocytic Infiltration of Skin

Since the original description of lymphocytic infiltration of the skin by Jessner and Kanof 1 in 1953 there has been much discussion regarding its specificity, for it is often difficult to decide when a constellation of clinical characteristics deserves recognition as a specific disease entity. Since all diseases have morphologic variations, it becomes a question of whether the clinical constellation is unique and deserves a separate place in classification or whether it represents only a variation of another clearly established syndrome. This is a particularly pertinent problem in the skin, because the accessibility of the organ to examination makes the slightest variation in clinical characteristic obvious and important. It is within this framework that we must consider the clinical and histologic characteristics of lymphocytic infiltration and its possible relationship to other disease entities. Jessner and Kanof1described discoid, elevated pink to red-brown lesions, usually on the face, as lymphocytic