Tom 9, Nr 2 (2024)
Obrazy w medycynie
Opublikowany online: 2024-02-26

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Eksport do Mediów Społecznościowych

Cutaneous pseudolymphoma, skin lymphoma or lymphoid papulosis

Przemysław J. Cuber12, Nikola Kłos2, Karolina Richter12, Tomasz Wojewoda12, Wojciech M. Wysocki123
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2024;9(2):170.

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Obrazy w onkologii / Pictures in oncology

Biuletyn Polskiego
Towarzystwa Onkologicznego
NOWOTWORY

2024, tom 9, nr 2, 170

© Polskie Towarzystwo Onkologiczne

ISSN: 2543–5248, e-ISSN: 2543–8077

www.nowotwory.edu.pl

Cutaneous pseudolymphoma, skin lymphoma or lymphoid papulosis

Przemysław J. Cuber12Nikola Kłos2Karolina Richter12Tomasz Wojewoda12Wojciech M. Wysocki123
1Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
2Department of Oncological Surgery, 5th Military Clinical Hospital in Krakow, Krakow, Poland
3Maria Sklodowska-Curie National Research Institute of Oncology, Scientific Editorial Office, Warsaw, Poland

Jak cytować / How to cite:

Cuber PJ, Kłos N, Richter K, Wojewoda T, Wysocki WM. Cutaneous pseudolymphoma, skin lymphoma or lymphoid papulosis. NOWOTWORY J Oncol 2024; 74: 158.

The terminology and classification of lymphoproliferative skin lesions is complex. It includes multivarious reactive conditions with diversified etiology and clinical picture. The cutaneous pseudolymphoma (PSL) term relates to a group of benign, reactive T- or B-cell lymphocyte-rich infiltrat. It is required to compare clinical presentation with histological findings to reach a correct diagnosis [1]. A wide range of causative agents (e.g. Borrelia, injections, tattoo, scars, arthropod-bite reaction) has been described, but most of the lesions are idiopathic [2]. Lymphomatoid papulosis is a benign, chronic T-cell lymphoma characterized by recurrent, spontaneously regressive papulonodular with tendency to necrotic lesions, often disseminated with histologic features suggestive of a CD30-positive lymphoma [3].

A 34-year-old male with a 12 mm firm lump on the right cheek without any specific signs or symptoms was referred by dermatologist with suspicion of cutaneous lymphoma, sarcoidosis or facial granuloma (fig.1). An incisional skin biopsy was nondiagnostic. The subsequent excisional biopsy indicated an ambiguous picture composed of a mixed population of lymphocytes with a predominance of small cells and the presence of histiocytes. Immunochemistry revealed a mixed population of T (CD3+) and B (CD20+) lymphocytes and a few small CD30+ lymphocytes (activated B and T lymphocytes with some atypic cells). Ki-67 proliferation index was 20–30%. The final pathology report revealed polimorphic lymphoid infiltration of T and B cell lines with the presence of atypical forms with immunoblast and centroblast morphology as well as single cells with multilamellar nuclei. Due to the lack of a granulocytic components, facial granuloma was excluded. A wide local excision of the residual lesion with the surrounding skin was undertaken. Preliminary pathology was suggestive of cutaneous pseudolymphoma, but the profound final pathology report was inconclusive, with a suggestion of either lymphoma or lymphomatoid papulosis, and a recommendation of further immunochemical analyses and incorporation of data from history and clinical picture.

Figure 1. The skin lesion on the right cheek before excision

The presented case illustrates the complexity of lymphoproliferative skin lesion diagnostics and the frequent lack of possibility in setting a final diagnosis despite all the available methods used.

References

  1. Romero-Pérez D, Blanes Martínez M, Encabo-Durán B. Cutaneous Pseudolymphomas. Actas Dermosifiliogr. 2016; 107(8): 640–651, doi: 10.1016/j.ad.2016.05.003, indexed in Pubmed: 27289134.
  2. Ploysangam T, Breneman DL, Mutasim DF. Cutaneous pseudolymphomas. J Am Acad Dermatol. 1998; 38(6 Pt 1): 877–95; quiz 896, doi: 10.1016/s0190-9622(98)70154-9, indexed in Pubmed: 9631994.
  3. Toumi A, Fazal S, Litaiem N. Lymphomatoid Papulosis. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL) 2024 Jan. 2023 May 22.



Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory