Heavy multinodular cutaneous lymphoid infiltrates: clinicopathologic features and B-cell clonality.
BACKGROUND
Criteria for distinguishing between cutaneous lymphoid hyperplasia (CLH) and low-grade B-cell lymphoma are not well defined. We examined the hypothesis that the presence of a clonal B-cell population in heavy multinodular lymphoid infiltrates correlates with clinical presentation and outcome.


METHODS
We identified 29 patients with skin lesions characterized histologically by a heavy dermal lymphocytic infiltrate with a multinodular architecture and extension into deep dermis and subcutaneous fat. Clonality was assessed immunophenotypically by light-chain restriction and also by analysis for IgH-gene rearrangement using PCR on DNA extracted from paraffin blocks.


RESULTS
Follow-up (mean 80 months; median 45 months) was obtained in all patients. Twenty-four patients (83%) presented with a solitary lesion: only four had solitary recurrences, and none developed multiple synchronous lesions or systemic B-cell lymphoma. However, 9/24 of these solitary lesions (38%) were clonal by light-chain restriction or IgH PCR; 5/29 patients (17%) presented with multiple recurrent lesions and continued to develop lesions during the period of follow-up; 3/5 patients (60%) with multiple lesions demonstrated a B-cell clone. No patient developed systemic B-cell lymphoma.


CONCLUSIONS
Heavy, multinodular cutaneous lymphoid infiltrates have an excellent prognosis. Multiple lesions at presentation are the best predictor of recurrent multiple lesions confined to the skin. The presence of a clonal B-cell population does not correlate with clinical presentation or histology, nor does it predict development of further lesions or systemic lymphoma.
Ceballos
K M
KM
Department of Pathology, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.
Gascoyne
R D
RD
Martinka
M
M
Trotter
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000473:pathology*; D002648:Child; D002999:Clone Cells; D004247:DNA / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics; D006801:Humans; D006965:Hyperplasia; D008221:Lymphoid Tissue / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019310:Pseudolymphoma / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D012871:Skin Diseases / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
D004247:DNA