A review of 55 cases of cutaneous lymphoid hyperplasia: reassessment of the histopathotogic findings leading to reclassification of 4 lesions as cutaneous marginal zone lymphoma and 19 as pseudo lymphomatous folliculitis

Department of Pathology, Saitama Medical School, Iruma-gun, Japan.
Human Pathlogy (Impact Factor: 2.81). 06/2005; 36(5):505-11. DOI: 10.1016/j.humpath.2005.02.012
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Pseudolymphomatous folliculitis (PLF) is a rare benign cutaneous lymphoid hyperplasia that most commonly occurs in the facial region as a dome-shaped or flat elevated nodule. We studied the clinicopathologic and immunohistochemical characteristics of 19 cases of PLF. The patients comprised 11 females and eight men (mean age 44.9; age range 9-77 years). All cases were solitary except one case with multiple lesions. The lesions were located in the facial region except one that was located in the back. Histologically, there was a diffuse or nodular lymphoid infiltrate with hyperplastic and distorted hair follicles and occasionally enlarged eccrine units with a clear nuclear morphology. Immunohistologically, three cases showed predominantly B-cells, eight cases predominantly B-cells with numerous T-cells, six cases predominantly T-cells with numerous B-cells, and two cases predominantly T-cells. All lesions showed increased numbers of perifollicular dendritic cells expressing anti-S-100 protein and CD1a. PLF is a rare, benign, cutaneous lymphoid hyperplasia that may resemble cutaneous lymphoma. It has characteristic clinical and pathologic features showing abundant periadnexal S-100/CD1a -positive dendritic cells with dilated and activated pilosebaceous units. The lesion may resolve with complete excision or present spontaneous regression.
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    ABSTRACT: Background Pseudolymphomatous folliculitis is a lymphoid proliferation that clinically and histopathologically mimics primary cutaneous extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). In this study we assessed the diagnostic value of three immunohistochemical markers, PD-1, CD1a, and S100.Methods We evaluated 25 cases of cutaneous lymphoid proliferations with established diagnoses, including 9 patients with pseudolymphomatous folliculitis, 11 with MALT lymphoma, and 5 with cutaneous lymphoid hyperplasia (CLH). The clinical, histopathologic, and immunohistochemical characteristics were reviewed and three major characteristics assessed: 1) proportion of T cells expressing PD-1, 2) pattern of expression of CD1a by dendritic cells, and 3) pattern of expression of S100 by dendritic cells.ResultsWe found pseudolymphomatous folliculitis to have a significant increase in PD-1+ T cells compared to MALT lymphoma (p < 0.0001). The pattern of CD1a staining is also informative: MALT lymphoma is significantly more likely to demonstrate a peripheral concentration of CD1a+ dendritic cells around lymphoid nodules than pseudolymphomatous folliculitis (p < 0.0003) or CLH (p < 0.05). Pseudolymphomatous folliculitis demonstrates an interstitial distribution of CD1a+ cells more often than MALT lymphoma (p < 0.04). S100 staining was not a helpful discriminator.Conclusions Histopathologic factors including PD-1 and CD1a staining patterns may allow for more certainty in distinguishing lymphoid hyperplasia, including pseudolymphomatous folliculitis, from MALT lymphoma.
    Journal of Cutaneous Pathology 11/2014; 42(1). DOI:10.1111/cup.12440 · 1.56 Impact Factor
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    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.
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