Lymphocytoma Cutis Workup

  • Author: Christine J Ko, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 26, 2010
 

Laboratory Studies

  • Biopsy is necessary to establish a diagnosis of lymphocytoma cutis and to exclude cutaneous lymphoma.
  • An adequate sample is essential. The specimen should be obtained by extending well into the subcutis while avoiding crush artifact.
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Other Tests

  • In some cases of lymphocytoma cutis, the possibility of lymphoma cannot be excluded by means of histologic analysis and immunostaining. In such cases, analysis for immunoglobulin or T-cell receptor genetic rearrangements may provide additional helpful information.
    • If a clone is identified, it increases the likelihood of lymphoma.
    • The results of this test should not be considered definitive.
    • Clonality is reported in occasional pseudolymphomas and may be absent in some lymphoma samples.
    • Clinical-pathologic correlation remains the criterion standard in the differential diagnosis.[6, 7, 8]
  • Antibodies to Borrelia burgdorferi may be identified in 50% of patients with borrelial lymphocytoma. The organism can be identified in tissue by means of polymerase chain reaction analysis. Also see the clinical trial, Borrelia Species in Cutaneous Lyme Borreliosis.
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Histologic Findings

Lymphocytoma cutis must be differentiated from lymphoma. Most cases of lymphocytoma cutis have a nodular inflammatory infiltrate and can simulate B-cell lymphoma.[9] The key histologic features that suggest lymphocytoma cutis instead of lymphoma include the presence of a mixed infiltrate that includes histiocytes, eosinophils, and plasma cells, in addition to lymphocytes.[10] In lymphocytoma cutis, the infiltrate tends to be top-heavy, whereas most lymphomas are centered in the deep dermis or subcutis. Samples of lymphocytoma cutis typically have germinal centers and tingible body macrophages, as shown in the images below. Occasionally, large lymphoid cells may be present; however, they rarely dominate the histologic picture.

A mixed inflammatory infiltrate with germinal centA mixed inflammatory infiltrate with germinal centers is indicative of lymphocytoma cutis. Well-developed lymphoid follicles in a background Well-developed lymphoid follicles in a background of mixed inflammatory cells with small lymphocytes are typical of lymphocytoma cutis.

Immunohistochemical staining may also be useful and generally shows a mixed B- and T-cell population with a high MIB-1–positive proliferative index. Staining for kappa and lambda light chains reveals a polyclonal pattern. Fresh, unfixed tissue may be required for adequate assessment of kappa and/or lambda labeling. Some cases of lymphocytoma cutis have a T-cell histologic pattern. Changes include a bandlike infiltrate in the papillary dermis, which predominantly includes small lymphocytes with variable epidermotropism. Although these features mimic those of cutaneous T-cell lymphoma or mycosis fungoides, the clinical presentation is characteristic.[11]

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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.

Specialty Editor Board

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.

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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.

References

  1. Colli C, Leinweber B, Mullegger 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. Kazandjieva J, Tsankov N. Tattoos: dermatological complications. Clin Dermatol. Jul-Aug 2007;25(4):375-82. [Medline].

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

  4. Welsh JP, Ko C, Hsu WT. Lymphomatoid drug reaction secondary to methylphenidate hydrochloride. Cutis. Jan 2008;81(1):61-4. [Medline].

  5. Porto DA, Comfere NI, Myers LM, Abbott JJ. Pseudolymphomatous reaction to varicella zoster virus vaccination: role of viral in situ hybridization. J Cutan Pathol. Nov 4 2009;[Medline].

  6. 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].

  7. 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].

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

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

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

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

 
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This example of lymphocytoma cutis shows a localized, erythematous-to-brown, ill-defined plaque.
Lymphocytoma cutis of the shoulder, composed of flesh-colored or erythematous nodules in small groups.
This photograph of lymphocytoma cutis caused by an arthropod bite shows an erythematous scaling patch of the scalp with localized secondary alopecia.
A mixed inflammatory infiltrate with germinal centers is indicative of lymphocytoma cutis.
Well-developed lymphoid follicles in a background of mixed inflammatory cells with small lymphocytes are typical of lymphocytoma cutis.
 
 
 
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