Pseudolymphoma, Cutaneous Clinical Presentation

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

History

  • Patients with B-cell pattern pseudolymphoma present with a nodule or a group of discrete nodules, usually with minimal associated symptoms.
  • Occasionally, cases present with pruritus or pain.
  • Patients with a T-cell pattern of cutaneous pseudolymphoma usually present with broader patches, which are often symptomatic.
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Physical

  • Examination of patients with a B-cell pattern of pseudolymphoma usually reveals a single nodule, from one to several centimeters in diameter. Although the lesions may be soft, they are more often firm. Typically, the lesions are red to purple in color, but they may show no coloration. Approximately three quarters of cases of cutaneous pseudolymphoma are localized. The remaining cases usually show grouped papules in a single defined region. More disseminated cases are rare. The most common site of involvement in cutaneous pseudolymphoma is the face (70%), followed by the chest and the upper extremities. Cutaneous pseudolymphoma lesions are infrequent below the waist.
  • Sites of predilection for borrelial pseudolymphoma include the earlobe, the nipple, the areola, the nose, and the scrotum (sites of low skin temperature).
  • Patients with T-cell pattern pseudolymphoma typically present with broad, erythematous patches and/or plaques, as shown in the image below. Pseudolymphomatous actinic reticuloid affects sun-exposed areas. Lymphomatoid contact dermatitis demonstrates lesions in areas where the inciting agent has come in contact with the skin.[5] This localized example of pseudolymphoma shows an This localized example of pseudolymphoma shows an ill-defined, thin, erythematous plaque.
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Causes

  • Most cases are idiopathic. Known inciting agents include tattoo dyes,[6] jewelry (eg, gold earrings), insect bites, medications, folliculitis, trauma, vaccinations,[7] other injectables (eg, liquid silicone[8] ), irritants, and infection (eg, varicella-zoster virus, Borrelia species, 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.

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. Brodell RT, Santa Cruz DJ. Cutaneous pseudolymphomas. Dermatol Clin. Oct 1985;3(4):719-34. [Medline].

  2. Choi TS, Doh KS, Kim SH, Jang MS, Suh KS, Kim ST. Clinicopathological and genotypic aspects of anticonvulsant-induced pseudolymphoma syndrome. Br J Dermatol. Apr 2003;148(4):730-6. [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. Maubec E, Pinquier L, Viguier M, et al. Vaccination-induced cutaneous pseudolymphoma. J Am Acad Dermatol. Apr 2005;52(4):623-9. [Medline].

  5. Braun RP, French LE, Feldmann R, Chavaz P, Saurat JH. Cutaneous pseudolymphoma, lymphomatoid contact dermatitis type, as an unusual cause of symmetrical upper eyelid nodules. Br J Dermatol. Aug 2000;143(2):411-4. [Medline].

  6. Kluger N, Vermeulen C, Moguelet P, et al. Cutaneous lymphoid hyperplasia (pseudolymphoma) in tattoos: a case series of seven patients. J Eur Acad Dermatol Venereol. Feb 2010;24(2):208-13. [Medline].

  7. 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].

  8. Michaels B, Michaels J, Mobini N. Prominent lymphoid infiltrate with a pseudolymphoma-like morphology: a new histological finding of injectable liquid silicone. J Cutan Pathol. Nov 2009;36(11):1224-6. [Medline].

  9. Gutermuth J, Audring H, Roseeuw D. Disseminated cutaneous B-cell lymphoma mimicking pseudolymphoma over a period of six years. Am J Dermatopathol. Jun 2004;26(3):225-9. [Medline].

  10. Braun RP, French LE, Feldmann R, Chavaz P, Saurat JH. Cutaneous pseudolymphoma, lymphomatoid contact dermatitis type, as an unusual cause of symmetrical upper eyelid nodules. Br J Dermatol. Aug 2000;143(2):411-4. [Medline].

  11. Burg G, Kerl H, Schmoeckel C. Differentiation between malignant B-cell lymphomas and pseudolymphomas of the skin. J Dermatol Surg Oncol. Apr 1984;10(4):271-5. [Medline].

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

  13. 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 localized example of pseudolymphoma shows an ill-defined, thin, erythematous plaque.
Pseudolymphomatous drug eruption due to captopril, marked by erythematous to purple papules, patches, and plaques.
This erythrodermic pseudolymphoma (T-cell pattern) typifies drug-induced pseudolymphoma, which is most often secondary to anticonvulsant therapy.
Biopsy specimens of pseudolymphoma vary substantially, but they most often exhibit a mixed inflammatory infiltrate with prominent lymphoid follicle formation.
 
 
 
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