A review of 55 cases of cutaneous lymphoid hyperplasia: Reassessment of the histopathologic findings leading to reclassification of 4 lesions as cutaneous marginal zone lymphoma and 19 as pseudolymphomatous folliculitis
To clarify the confusion surrounding the diagnosis of cutaneous lymphoid hyperplasia (CLH) that was formerly described as lymphadenosis benigna cutis, lymphocytoma cutis, or lymphocytic infiltration of Jessner and to assess whether newly recognized diagnoses, such as cutaneous marginal zone lymphoma and pseudolymphomatous folliculitis (PLF), may have been overlooked, we reexamined 55 Japanese cases of nonepidermotropic lymphoproliferative disorder that had previously been diagnosed as "cutaneous pseudolymphoma." In all these cases, the immunohistochemical expressions of CD1a, CD3, CD4, CD8, CD20, CD21, CD30, CD43, CD56, CD68, CD79a, kappa and lambda chains, S-100 protein, and latent membrane protein were assessed. In addition, in 13 cases the gene rearrangement of the immunoglobulin heavy chain was investigated using a polymerase chain reaction method. As a result of these investigations, we have identified 4 cases of cutaneous marginal zone lymphoma, 19 cases of PLF, 1 case of diffuse large B-cell lymphoma, and 2 cases of solitary nonepidermotropic pseudo-T-cell lymphoma, with the remaining 29 cases being CLH. Cutaneous marginal zone lymphoma, which represented 7.3% of the total, was distinguished from CLH by the presence of patchy or diffuse proliferation of centrocyte-like cells, plasma cells at the periphery of the lymphocytic infiltration, monotypic restriction of the light chains, and gene rearrangement of the immunoglobulin heavy chain. Pseudolymphomatous folliculitis was identified by the presence of activated pilosebaceous units with abundant CD1a-and S-100 protein-positive T-cell-activated dendritic cells. Of the cases that were reassessed, 34.5% were PLF.
"The localized form accounts for 70% of cases, occurring predominantly on the face or
upper limbs. The disseminated form is rarer, found mostly in elderly people, affecting
the midsection and extremities, in addition to the face.5-6,8 The clinical condition in which there is dissemination of
lesions is termed miliary lymphocytoma cutis.2,5 "
[Show abstract][Hide abstract] ABSTRACT: We describe a clinical case involving a 62-year-old white male, diagnosed with
lymphocytoma cutis (Spiegler-Fendt sarcoid) in the cephalic segment. The diagnosis
was carried out by pathological study and confirmed by immunohistochemical panel:
evidence of polyclonality. Phototherapy sessions were suggested as treatment (13 PUVA
sessions, with an accumulated dose of 58.65 J/cm2 ). The improvement was
partial. Thus, infiltration of triamcinolone was opted for (one intralesional
infiltration every 3 weeks). After 5 sessions, satisfactory improvement was observed:
regression of nearly all the lesions.
"The term cutaneous pseudolymphoma is used for a group of disorders with lymphocytic infiltration that histologically resembles cutaneous lymphoma . Although these conditions were formally known as lymphadenitis benigna cutis, CLH is the currently recommended term [7, 8]. Recently, Arai et al.  reported that the infiltrating cells in CLH are composed of a variety of mature lymphocytes, including CD3, CD4 and CD8. "
[Show abstract][Hide abstract] ABSTRACT: Cutaneous lymphoid hyperplasia (CLH) is difficult to differentiate from primary malignant cutaneous lymphomas that may present as solitary nodules, and sometimes it requires much time to achieve a final diagnosis. A recent report [Park et al.: Acta Haematol 2011;126:79-86] suggested that the expression of granulysin correlates with the prognosis of cancer patients, even in hematological disorders. In this report, we immunohistochemically examine the expression of cytotoxic molecules (e.g. granulysin, TIA-1 and perforin) in tumor-infiltrating lymphocytes of 10 patients with CLH and 3 patients with cutaneous diffuse large B cell lymphoma, not otherwise specified (CDLBCL-NOS) of the face. In the patients with CLH, the number of granulysin-bearing cells was higher than in the patients with CDLBCL-NOS. In contrast, there was no difference in the number of TIA-1(+) or perforin(+) cells. The present study attempts to explain the different biological behaviors of these two hematological disorders and suggests granulysin as a possible diagnostic tool for CLH and CDLBCL-NOS of the face.
Case Reports in Dermatology 03/2013; 5(1):88-92. DOI:10.1159/000350567
"Reactive lymphoid hyperplasia (RLH) is reported to occur in the gastrointestinal tract , skin , lung , thyroid , orbit , and pancreas ; however, it is very rarely reported in the liver. To the best of our knowledge, only 12 cases with RLH of the liver have so far been reported in the English literature [7-15]. "
[Show abstract][Hide abstract] ABSTRACT: Reactive lymphoid hyperplasia (RLH) of the liver is very rarely reported, and we encountered two cases of RLH of the liver in a patient with colon cancer.
In the first case, a 77-year-old woman was admitted for the surgical removal of a ascending colon cancer. A hepatic tumor in the left lobe was concurrently revealed by computed tomography (CT), and magnetic resonance imaging (MRI). The appearance suggested liver metastasis. Right hemicolectomy and partial hepatectomy were performed. On histopathological examination, lymphoid follicles with germinal centers were seen in the tumor-like lesion, and remarkable lymphoid infiltration with germinal centers was seen in the portal area around the nodule. Immunohistochemical studies revealed polyclonality of infiltrating lymphocyte. Consequently, this nodular lesion was diagnosed as RLH of the liver. In the second case, a 64-year-old woman who had a radical right hemicolectomy for stage II ascending colon cancer 10 years ago was admitted with dysuria. A hepatic tumor in the left lobe was concurrently revealed by CT and MRI, suggesting hepatocellular carcinoma. A left lateral segmentectomy was performed. Microscopically, this lesion revealed the almost same findings as the first case, so this nodular lesion was diagnosed as RLH of the liver.
Our two cases were the first report of RLH of the liver accompanying colon cancer. Because there are a very few cases, so it is not clear whether the malignancies were involved in the onset of RLH. But we believe that new factors involved in the onset mechanism of RLH may be identified by carefully monitoring the clinical course of our two patients.
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