Pseudolymphoma, Cutaneous Workup

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

Other Tests

  • In some cases of cutaneous pseudolymphoma, 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.[9] Clinical-pathologic correlation is essential.[10]
  • In patients with borrelial pseudolymphoma, antibodies to Borrelia burgdorferi may be identified in 50% of cases. Additionally, the organism may be identified in tissue via polymerase chain reaction (PCR) analysis. Also see the clinical trial, Borrelia Species in Cutaneous Lyme Borreliosis.
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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.
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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, as shown in the image below.[11]

Biopsy specimens of pseudolymphoma vary substantiaBiopsy specimens of pseudolymphoma vary substantially, but they most often exhibit a mixed inflammatory infiltrate with prominent lymphoid follicle formation.

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- and T-cell population with a high MIB-1–positive proliferative fraction.[12] 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.[13]

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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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