eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Lymphocytoma Cutis

Author: Christine J Ko, MD, Assistant Professor, Departments of Dermatology and Pathology, Yale University School of Medicine
Coauthor(s): Jon H Meyerle, MD, Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Consulting Staff, Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center; Earl J Glusac, MD, Professor, Departments of Pathology and Dermatology, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Oct 22, 2008

Introduction

Background

Lymphocytoma cutis is not a specific disease. Rather, it is a response to a variety of known and unknown stimuli that results in the accumulation of lymphocytes and other inflammatory cells in a localized region. Lymphocytoma cutis is known to simulate lymphoma, as reflected primarily by the histologic findings. However, it is a reactive process and generally has a benign course. When known, the inciting agent should be included in the diagnosis. The term lymphocytoma cutis or pseudolymphoma without modification should be reserved for idiopathic cases.

Related articles include Cutaneous B-Cell Lymphoma and Cutaneous T-Cell Lymphoma. Additionally, the Medscape Skin Cancer Resource Center may be of interest.

Pathophysiology

In lymphocytoma cutis, lymphocytes and other inflammatory cells are recruited to a localized area of the skin in response to known or unknown stimuli. Most cases are idiopathic. Lymphocytoma cutis is not considered a lymphocytic response to malignancy.

Cases with known etiologies involve a reaction to tattoo dye, jewelry (especially gold), arthropod bites, medications, folliculitis, trauma, infections (ie, with Borrelia burgdorferi, molluscum contagiosum), vaccinations, and acupuncture.

A discrete subset of lymphocytoma cutis, borrelial lymphocytoma, occurs primarily in Europe, in areas in which the Ixodes ricinus tick is endemic. This form of the disease is a response to an infection due to Borrelia burgdorferi subsp afzelius that is transmitted by a tick bite.1

Frequency

United States

No data are available.

International

No data are available. The condition is uncommon but not rare. A discrete subset of lymphocytoma cutis, borrelial lymphocytoma, occurs primarily in Europe, in areas in which the I ricinus tick is endemic.

Mortality/Morbidity

Lymphocytoma cutis is not associated with mortality. It is rarely associated with morbidity other than minor pain or pruritus. It generally heals without scarring.

Race

No racial predilection is noted.

Sex

The female-to-male ratio in reported cases is approximately 2:1.

Age

Individuals of any age may be affected, but lymphocytoma cutis is most common in early adulthood.

  • The mean patient age at onset is 34 years. Approximately 8% of cases involve patients younger than 18 years.
  • Two thirds of patients are younger than 40 years at the time of biopsy.
  • Borrelial lymphocytoma is more common in children than adults and is most often observed in Europe.

Clinical

History

  • Patients present with a nodule or group of discrete nodules, usually with minimal associated symptoms.
  • Occasionally, pruritus or pain is noted.

Physical

  • Examination usually reveals a single nodule with a diameter of one to several centimeters.
  • Although the lesions may be soft, they are more often firm.
  • Typically, the lesions are red to purple but can be absent of color as well.
  • Approximately three quarters of the cases involve localized lesions.
    • The remaining cases usually involve grouped papules in a single defined region.
    • More disseminated cases are rare.
  • The most common site of involvement is the face (70%).
  • Next most common sites are the chest and upper extremities.
  • Lesions below the waist are uncommon.
  • Sites of predilection for Borrelial lymphocytoma are sites with low skin temperature, including the following:
  • Earlobes
  • Nipples and areolae
  • Nose
  • Scrotum

Causes

Most cases are idiopathic. Known inciting agents include the following:

  • Tattoo dye
  • Jewelry (eg, gold earrings)
  • Arthropod (insect and spider) bites
  • Medications2
  • Folliculitis
  • Trauma
  • Vaccinations
  • Materials that come into direct contact with the skin or are injected into the skin (eg, gold, aluminum)
  • Infection (eg, varicella-zoster virus, Borrelia species, molluscum contagiosum, Helicobacter pylori)
  • Sites where acupuncture needles were inserted

More on Lymphocytoma Cutis

Overview: Lymphocytoma Cutis
Differential Diagnoses & Workup: Lymphocytoma Cutis
Treatment & Medication: Lymphocytoma Cutis
Follow-up: Lymphocytoma Cutis
Multimedia: Lymphocytoma Cutis
References
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References

  1. Colli C, Leinweber B, Müllegger R, Chott A, Kerl H, Cerroni L. Borrelia burgdorferi-associated lymphocytoma cutis: clinicopathologic, immunophenotypic, and molecular study of 106 cases. J Cutan Pathol. Mar 2004;31(3):232-40. [Medline].

  2. Albrecht J, Fine LA, Piette W. Drug-associated lymphoma and pseudolymphoma: recognition and management. Dermatol Clin. Apr 2007;25(2):233-44, vii. [Medline].

  3. Kempf W, Dummer R, Burg G. Approach to lymphoproliferative infiltrates of the skin. The difficult lesions. Am J Clin Pathol. Jan 1999;111(1 Suppl 1):S84-93. [Medline].

  4. Wantzin GL, Hou-Jensen K, Nielsen M, Petri J, Thomsen K. Cutaneous lymphocytomas: clinical and histological aspects. Acta Derm Venereol. 1982;62(2):119-24. [Medline].

  5. van Vloten WA, Willemze R. The many faces of lymphocytoma cutis. J Eur Acad Dermatol Venereol. Jan 2003;17(1):3-6. [Medline].

  6. Duncan SC, Evans HL, Winkelmann RK. Large cell lymphocytoma. Arch Dermatol. Oct 1980;116(10):1142-6. [Medline].

  7. Geerts ML, Kaiserling E. A morphologic study of lymphadenosis benigna cutis. Dermatologica. 1985;170(3):121-7. [Medline].

  8. Ploysangam T, Breneman DL, Mutasim DF. Cutaneous pseudolymphomas. J Am Acad Dermatol. Jun 1998;38(6 Pt 1):877-95; quiz 896-7. [Medline].

  9. Connors RC, Ackerman AB. Histologic pseudomalignancies of the skin. Arch Dermatol. Dec 1976;112(12):1767-80. [Medline].

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Further Reading

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Keywords

cutaneous B- or T-cell pseudolymphoma, cutaneous lymphoid hyperplasia, pseudolymphoma without modification, pseudolymphoma of Spiegler and Fendt, sarcoidosis of Spiegler and Fendt, cutaneous lymphomatous hyperplasia, lymphadenosis benigna cutis, cutaneous lymphoplasia, Ixodes ricinus, Borrelia burgdorferi subsp afzelius, varicella zoster, molluscum contagiosum

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Contributor Information and Disclosures

Author

Christine J Ko, MD, Assistant Professor, Departments of Dermatology and Pathology, Yale University School of Medicine
Christine J Ko, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and International Society of Dermatopathology
Disclosure: Nothing to disclose.

Coauthor(s)

Jon H Meyerle, MD, Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Consulting Staff, Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi
Disclosure: Nothing to disclose.

Earl J Glusac, MD, Professor, Departments of Pathology and Dermatology, Yale University School of Medicine
Earl J Glusac, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Günter Burg, MD, Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland
Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Daniel S Loo, MD, Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center
Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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