eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Pseudolymphoma, Cutaneous: Differential Diagnoses & Workup

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

Differential Diagnoses

Contact Dermatitis, Irritant
Lymphomatoid Papulosis

Other Problems to Be Considered

Actinic reticuloid
Basal cell epithelioma (other adnexal tumors)
Lymphoma
Malignant B-cell lymphoma

Workup

Other Tests

  • In some cases, the possibility of lymphoma cannot be excluded by histologic analysis and immunostaining. In such cases, analysis for immunoglobulin or T-cell receptor gene rearrangements may provide additional helpful information. If a clone is identified, it increases the likelihood of lymphoma. However, this test should not be considered definitive. Clonality has been documented in occasional pseudolymphomas and may be absent in some lymphoma samples.6 Clinical-pathologic correlation is essential.7
  • In patients with borrelial pseudolymphoma, antibodies to B burgdorferi may be identified in 50% of cases. Additionally, the organism may be identified in tissue via polymerase chain reaction (PCR) analysis.

Procedures

  • Biopsy is necessary to establish a diagnosis of pseudolymphoma. An adequate sample extending well into the subcutis with avoidance of crush artifact is essential.

Histologic Findings

Lymphocytoma cutis must be differentiated from lymphoma. Most examples simulate B-cell lymphoma and show a nodular inflammatory infiltrate in the dermis. The key histologic features that favor pseudolymphoma over lymphoma include the presence of a mixed infiltrate that includes histiocytes, eosinophils, and plasma cells, in addition to lymphocytes (see Media File 4).8 The infiltrate in lymphocytoma cutis tends to be more top-heavy, while most lymphomas are centered in the deep dermis or the subcutis. Lymphocytoma cutis typically shows germinal centers and tingible body macrophages. Occasional large lymphoid cells may be present; however, they rarely dominate the histologic picture.

Immunohistochemical staining may also be useful and generally shows a mixed B-cell and T-cell population with a high MIB-1 + proliferative fraction.9 Staining for kappa and lambda light chains shows a polyclonal pattern of staining. Fresh, unfixed tissue may be required for adequate assessment of kappa/lambda labeling.

Some cases show a T-cell histologic pattern with a bandlike infiltrate in the papillary dermis, predominantly of small lymphocytes, with variable epidermotropism. Although these features mimic cutaneous T-cell lymphoma/mycosis fungoides, the clinical presentation is often characteristic.10

More on Pseudolymphoma, Cutaneous

Overview: Pseudolymphoma, Cutaneous
Differential Diagnoses & Workup: Pseudolymphoma, Cutaneous
Treatment & Medication: Pseudolymphoma, Cutaneous
Follow-up: Pseudolymphoma, Cutaneous
Multimedia: Pseudolymphoma, Cutaneous
References
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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, Caux F, Amsler E, Aractingi S, 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. 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].

  7. 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].

  8. 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].

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

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

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

  12. Rijlaarsdam U, Willemze R. Cutaneous pseudo-T-cell lymphomas. Semin Diagn Pathol. May 1991;8(2):102-8. [Medline].

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Further Reading

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Keywords

lymphocytoma cutis, cutaneous lymphomatous hyperplasia, lymphadenosis benigna cutis, cutaneous lymphoplasia

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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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