It was reported as a case of pseudoleukemic infiltration of the skin. Lymphocytoma cutis primary care dermatology society uk. Major advances have been made in the histologic classification. Chapter 1 introducton histopathology definition it is a branch of pathology which deals with the study of disease in a tissue section. Clinical findings the localized form of bpsl presents with a solitary nodule, measuring up to 4 cm in most of the cases. It is a process that simulates a cutaneous lymphoma blood cell cancer developing in the skin, but it behaves in a harmless manner. Biopsies taken from patients soon after a tick bite show the tick head and neighboring skin with edema, vascular dilation, extravasation of. Borreliaassociated bcell pseudolymphoma lymphocytoma cutis and lymphadenosis cutis benigna often are synonymously used. Lymphocytoma cutis is a rare pseudolymphoma that has also been known as cutaneous lymphoid hyperplasia or lymphadenosis benigna cutis. In most cases, the causation is unknown, but a variety of stimuli are known to induce lymphocytoma cutis, many of which are potentially relevant to everyday diagnostic practice. Case report lymphadenosis benigna cutis or cutaneous. In cutaneous pseudolymphoma, resemblance to lymphoma is usually most apparent histologically, but some examples may also mimic lymphoma clinically. Lymphadenosis benigna cutis, lymphocytoma cutis, pseudolymphomas. Pseudolymphomas are also denominated cutaneous lymphoid hyperplasia clh, which better describes their benign clinical course.
About 8590% of nonhodgkin lymphomas are derived from b cells, whereas the remaining lymphomas are derived from t cells or nk cells. A diffuse lymphoid infiltrate is seen throughout the entire cutis. Localized lymphocytoma cutis, the most common form, may occur in both children and adults and has a short course. Bernard ackerman, md, almut boer, md, bruce bennin, md, geoffrey j. Grouped erythematous papules and plaques on the trunk. Large cell lymphocytomaa clinicopathological study, clinical. Various terms have been used for the benign processes which clinically and histologically resemble.
Borrelial lc occurs most commonly in areas endemic for ixodes ricinus tick in europe, and it is rare in north america. Editor, lymphocytoma cutis is a benign lymphoid hyperplasia which typically occurs over the head and neck. The areas of predilection are the ear lobe, nipple and areola, and scrotal area. Characteristic histopathology of cutaneous lymphoplasia. However, histology showed a nodular dermal lymphoid infiltrate of centrocytelike cells with only scanty scattered blasts. Lymphocytoma cutis, or benign reactive lymphoid hyperplasia, is an.
In most cases, the causation is unknown, but a variety of stimuli are known to induce lymphocytoma cutis, many of which are potentially relevant to. The terms lymphocytoma cutis and cutaneous lymphoid hyperplasia have also been used historically and come under the same umbrella. Clinically, it is characterized by a bluered plaque or nodule of 15 cm in. Haemogram, urinalysis, biochemical parameters, ultrasonography. Kimu ras disease is characterized by the marked increase. Erythema migrans and borrelial lymphocytoma are early signs of lyme borreliosis. Apr 29, 2016 lymphocytoma cutis is a subtype of cutaneous pseudolymphoma involving the face, chest, and upper extremities. Lymphocytoma cutis, or spieglerfendt sarcoid, is classed as one of the pseudolymphomas, referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resembles. After infection with borrelia burgdorferi via a tick bite, the body undergoes a series of events in an attempt to destroy the microorganism or limit its spread to other sites. Excised one month prior to presentation with recurrence. There may be isolated lesions or regionalareas of localization. Cutaneous bcell pseudolymphoma bpsl is often also referred as lymphocytoma cutis or cutaneous lymphoid hyperplasia.
We report a case of lymphocytoma cutis with conjunctival lesions. In cutis laxa, dermal elastic fibres are both altered and reduced in. Major advances have been made in the histologic classification, immunohistochemistry, and. Histopathology remains one of the major tools of diagnosis in mycology20 table 3. The tissue undergoes a series of steps before it reaches the examiners desk to be thoroughly examined microscopically to arrive at a particular diagnosis. Lymphocytoma cutis with conjunctival lesions british. The diagnosis is based on histology, the clinical context history of tick bite and localization at predilection site, serologic findings, andor detection of borrelia burgdorferi species dna in the tissue by pcr. Nonhodgkin lymphoma includes a diverse spectrum of cancers of the immune system. In those instances, the lesions presented without an inciting incident, became more pronounced, and. Due to this vast array of characteristics, the lesion is most. The many faces of lymphocytoma cutis wiley online library. A characteristic histologic feature common to all 115 cases was the presence of large pale reticulum cells containing one or more round polychrome bodies. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
Pdf lymphocytoma cutis, also known as cutaneous b cell. Clh lesions may closely resemble lymphoma both clinically and histologically. Subcutaneous lymphatic follicle formation and eosinophilic infiltration are observed histopathologically. Pseudolymphomas can be categorized according to predominant cell type b cell, t cell and mixed and pattern of inflammation including bandlike and. Lymphocytoma cutis, also known as cutaneous b cell pseudolymphoma, represents a spectrum of disease that shares similar clinical and histological features and simulates cutaneous lymphoma clinically and histologically. Lymphocytoma cutis case report 129 more unlikely hypotheses were. The accurate diagnosis of cutaneous pseudolymphoma depends on critical elements from the clinical history, physical exam, histologic, andor adjunctive studies that make the particular case fall short of the diagnosis of confirmed cutaneous lymphoma. Cutaneous pseudolymphoma refers to a heterogenous group of benign reactive tcell or bcell lymphoproliferative processes of diverse causes that simulate cutaneous lymphomas clinically and histologically. In most cases the infiltrate is located in the papillary dermis top heavy. Lymphocytoma cutis, or spieglerfendt sarcoid, is classed as one of the.
It is suggested that the cases described represent different parts of a spectrum running from lymphocytoma cutis. The disease is rarely seen in india and may cause diagnostic difficulties for dermatologist residing in parts of the world that are not endemic for lyme disease. By immunological and enzyme cytochemical methods the cells were identified as t lymphocytes. Typically, the lesions are small, superficial, translucent, firm, nontender, pinkishred.
Clinically it is manifested as asymptomatic, indolent, nodular lesions of different sizes varying between 2 and 5 cm, usually solitary, mainly on exposed area of the. In 1923, bilerstein coined term lymphocytoma cutis term lymphadenosis benigna cutis was introduced by bafverstedt in 1943 in 1967, lever introduced term pseudolymphoma of spiegler and fendt subsequently,caro and helwig in. In europe, cutaneous lymphoid hyperplasia lymphocytoma cutis has been associated with borrelia infection and is said to be the most common cause in endemic areas. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. The clinical impression was that of lymphocytoma cutis and the lesions were treated with intralesional steroids resulting in prompt resolution leaving behind only flat discoloured areas. It occurs both in adults and children, with a slight female predominance 2.
Depending on aetiology, cbpl is also known as cutaneous lymphoid hyperplasia, lymphocytoma cutis, sarcomatosis cutis of spieglerfendt and bafverstedt syndrome. As of 2016, the current approach to classification uses the who classification scheme. Lymphocytoma cutis is a rare, chronic, benign cutaneous bcell lymphoproliferative condition usually presenting with redpurple papules, nodules or plaques predominantly on the head and neck. It clinically presents as skincolored to darkred papules, nodules, or infiltrative plaques similar in appearance to cutaneous malignant lymphoma. Hence, it was thought worthwhile to report the same, focusing attention, in particular, to its diagnostic clinical criteria, supported by histopathology, immunohistochemistry ihcprevalent nomenclature, and its differential diagnosis. Lymphocytoma cutis lc is one of the most common types of cutaneous b cell pseudolymphoma. Cutis laxa is characterised by fragmentation of cutaneous elastic fibres, giving rise to loose, sagging skin which may give the appearance of premature aging. Cutaneous lymphoid hyperplasia an overview sciencedirect. Sarcomatosis cutis, lymphocytoma cutis, lymphadenosis benigna cutis, pseudolymphoma of spiegler and fendt, and actinic reticuloid are other accepted terminologies to describe cpl 1, 2. Dermatopathology reference describes cutis laxa histopathology including histologic features and provides links to additional medical references. The diagnosis is mainly based on histopathology and immunohistochemistry. Nov 28, 2012 lymphocytoma cutis, or spieglerfendt sarcoid, is classed as one of the pseudolymphonas, 1 referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resemble, clinically and histopathologically, cutaneous lymphomas. Inflammatory dermatoses mimicking malignancy pseudolymphoma. The clinical differential diagnosis in each variety is difficult and includes numerous infiltrative disorders.
Cutaneous lymphoid hyperplasia clh is considered a benign lymphoid reactive process that results from various antigenic stimuli and may have potential for progression to overt lymphoma. Courtesy of stuart lessin, md diagnosis confirmation. Biopsy of borrelial lymphocytoma taken from the ear lobe of an iiyearold girl. Sarcomatosis cutis to denote benign formation resembling a sarcoma. Pdf editor, lymphocytoma cutis is a benign lymphoid hyperplasia which typically occurs over the head and neck. One hundred fifteen cases of cutaneous lymphoplasia lymphocytoma were examined histologically. Two cases of disseminated lymphocytoma cutis are reported. In some cases extracutaneous sites are involved including the lung and gastrointestinal tract histology of cutis laxa. The serum calcium dosage was applied, as a hypercalcemia suggested the diagnosis of sarcoidosis. Erythema migrans em is an acute, selflimited lesion, often located in or near the groin, axilla, or popliteal fossa. Case report lymphadenosis benigna cutis or cutaneous lymphoid. Interpretation of cutaneous lymphoid infiltrates is one of the most troublesome areas of diagnostic dermatopathology.
Histopathology is an important tool in the diagnosis of cpl, and is necessary to distinguish cpl from reactive cutaneous inflammatory cell infiltrates, and lymphoma. Lymphocytoma cutis cutaneous lymphoid hyperplasia, cutaneous bcell pseudolymphoma, spieglerfendt sarcoid is an entity encompassing a spectrum of benign bcell lymphoproliferative diseases that share clinical and histopathologic features. Various stimuli can induce lymphocytoma cutis, but in most cases the cause is not known. The many faces of lymphocytoma cutis van vloten 2003 journal. Lymphocytoma as a diagnostic term has been used since 1923 to designate cutaneous proliferations of lymphoid cells without detectable extracutaneous involvement. Cutaneous presentation of orbital follicular lymphoma. Lymphocytoma cutis lcc is a cutaneous bcell pseudolymphoma representing a wide variety of disorders that share clinical and histologic features. Department of pathology, j n medical college, amu, aligarh, uttar pradesh, india. Clh has had a wide variety of names, including spieglerfendt sarcoid, lymphocytoma cutis, and lymphadenosis benigna cutis. This form of the disease is a response to an infection due to borrelia burgdorferi subsp afzelius that is transmitted by a tick bite. Pdf we describe a clinical case involving a 62yearold white male, diagnosed with lymphocytoma cutis spieglerfendt sarcoid in the cephalic.
Gottlieb, md a classic reference tool to help users identify basic histopathologic patterns of inflammatory skin diseases. The patient reported having similar episodes dating back to his early 20s. The major advantages of histopathology are speed, low cost and the ability to provide a presumptive identification of the infecting fungus as well as demonstrating the tissue reaction. Borrelial lymphocytoma the term lymphadenosis benigna cutis labc was intro duced by bafverstedt in 1943 and applies to lesions that may appear in a solitary or a disseminated form labc dispersa. Abstract lymphadenosis benigna cutis or cutaneous lymphoid hyperplasia or lymphocytoma cutis or pseudolymphoma is classified as one of the inflammatory disorder in which accumulation of lymphocytes on skin resemble, clinically and histologically as, cutaneous lymphomas. Liver and intrahepatic bile ducts tumor reactive lymphoid hyperplasia pseudolymphoma. Lymphocytoma cutis is a benign lymphocyte hyperplasia bcell reaction to an antigen such as a red tattoo, borrelia burgdorferi, injected drug, vaccine that prefers the head and neck region,and can be associated with sunlight sensitivity. Jun 26, 2016 historical aspects cutaneous pseudolymphomacpl was first described under the term sarcomatosis cutis by kaposi in 1891. Discussion cutis laxa is a rare disease which may be hereditary or acquired.
Borrelial lymphocytoma bl is a subacute lesion, typically on the ear or breast, that eventually resolves 4, 26. It has a worldwide distribution and affects all races and ethnic groups equally. The many faces of lymphocytoma cutis van vloten 2003. In 1906 jadassohn 1 presented before the ninth german dermatological congress the first case of what was later to be known as lymphocytoma cutis.
Histologic features help differentiate lymphocytoma cutis from cutaneous malignant lymphoma. Cutaneous b cell pseudolymphomas previously called lymphadenosis benigna cutis, lymphocytoma cutis, pseudolymphoma of spieglerfendt, or cutaneous lymphoid hyperplasia represent a reactive bcell proliferation response to a variety of antigenic stimuli, including arthropod bites, gold pierced earrings, tattoo dyes, and drugs. The term pseudolymphoma has been used to classify cases of benign lymphoid infiltrates that mimic lymphoid malignancy. Lymphocytoma cutis, or spieglerfendt sarcoid, is classed as one of the pseudolymphonas, 1 referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resemble, clinically and histopathologically, cutaneous lymphomas. It presents as red or violaceous nodules or plaques and is commoner in females. Acrodermatitis chronica atrophicans aca is a slowly progressive lesion located primarily on the extensor. Welldemarcated plaque, 4 x 5 cm in size consisting of grouped erythematous shiny papules and nodules. Cutaneous lymphoma has a worse prognosis and treatment response. A 34yearold man presented to the outpatient dermatology clinic with 3 groups of mildly pruritic, erythematous papules and plaques on the right posterior shoulder, left midback, and left serratus anterior muscle. We present a case of a 54yearold woman who spontaneously developed lesions of unknown cause consistent with clh. Histopathology of skin revealed fragmentation of and diminution in the elastic fibres without any evidence of calcification.
Cutaneous lymphoid hyperplasia refers to a groups of benign cutaneous disorders characterized by collections of lymphocytes, macrophages, and dendritic cells in the skin 725 conditions included in this groups are 725 cutaneous lymphoid hyperplasia with nodular pattern, a condition of the skin characterized by a solitary or localized cluster of asymptomatic erythematous to violaceous. Historical aspects cutaneous pseudolymphomacpl was first described under the term sarcomatosis cutis by kaposi in 1891. What you should be alert for in the history solitary persistent lesion on the skin sometimes several grouped lesions generalized scattered lesions are uncommon either itchy or asymptomatic common triggers. Histopathologic patterns of erythema migrans and borrelial. In 1922, when discussing bibersteins 2 case, jadassohn commented that his original patient was still living, that the skin lesions were unchanged and that no. Dermatopathology reference describes lymphocytoma cutis spiegler fendt sarcoid histopathology including histologic features and provides links to additional medical references. Pseudolymphomas may arise in response to a wide variety of foreign antigens, but most are idiopathic. The prevalence of borrelia lymphocytoma cutis has been reported to be from 0. Jul 31, 20 dermatopathology reference describes lymphocytoma cutis spiegler fendt sarcoid histopathology including histologic features and provides links to additional medical references. Lymphocytoma cutis is the name for a group of skin disorders defined as benign. In areas endemic for the tick, ixodes ricinus, this disease is more common.
1271 505 1526 1465 1339 503 1472 396 941 1206 1455 1343 984 676 1365 202 1523 1131 577 31 1151 1450 353 1397 693 833 218 1029 669 523 17 906 1334 313 777 1150 662 1068 436 992