title: Cutaneous lymphoid hyperplasia and other lymphoid infiltrates of the breast nipple: a retrospective clinicopathologic study of fifty-six patients.
abstract: This study characterizes the clinicopathological spectrum of lymphoproliferations involving the breast nipple and/or areola. Morphologic, immunohistochemical, molecular-genetic, and clinical features of 58 specimens from 56 patients were analyzed. They were re-diagnosed as cutaneous lymphoid hyperplasia (CLH, n = 44); other benign lymphoid infiltrates (OBLI, n = 8); peripheral T-cell lymphoma, not otherwise specified (n = 1); cases with overlapping features of CLH and B-cell lymphoma (n = 3), one of them composed of spindle cells. Cutaneous lymphoid hyperplasia infiltrates were dense, composed mainly of B cells forming follicles with germinal centers (GC). Cutaneous lymphoid hyperplasia frequently showed features suggesting a malignancy as coalescing follicles with non-polarized germinal centers lacking mantle zones, and smudged infiltrates of lymphoid cells spreading into collagen (often as "Indian files"), smooth muscle, vessel walls, and nerve sheaths. Only two cutaneous lymphoid hyperplasias recurred; otherwise all patients are without disease (mean follow-up 62 months). Monoclonal rearrangement of immunoglobulin heavy chain gene was detected in five, and of T-cell receptor gamma gene in two cutaneous lymphoid hyperplasias using polymerase chain reaction (PCR), but the patients fared well too. In 47% of cases Borrelia burgdorferi was detected by polymerase chain reaction and/or serology, of which one was monoclonal. We conclude that cutaneous lymphoid hyperplasia is the most common lymphoproliferation of the breast nipple, rarely recognized clinically, and often overdiagnosed histologically as lymphoma.
authors.affiliation: Department of Pathology, Medical Faculty Hospital, Charles University, Pilsen, Czech Republic.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Boudova
authors.forename: Dmitry V
authors.initials: DV
authors.lastname: Kazakov
authors.forename: Radek
authors.initials: R
authors.lastname: Sima
authors.forename: Tomas
authors.initials: T
authors.lastname: Vanecek
authors.forename: Emina
authors.initials: E
authors.lastname: Torlakovic
authors.forename: Janez
authors.initials: J
authors.lastname: Lamovec
authors.forename: Heinz
authors.initials: H
authors.lastname: Kutzner
authors.forename: Peter
authors.initials: P
authors.lastname: Szepe
authors.forename: Lukas
authors.initials: L
authors.lastname: Plank
authors.forename: Jirí
authors.initials: J
authors.lastname: Bouda
authors.forename: Ondrej
authors.initials: O
authors.lastname: Hes
authors.forename: Petr
authors.initials: P
authors.lastname: Mukensnabl
authors.forename: Michal
authors.initials: M
authors.lastname: Michal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D025065:Borrelia burgdorferi; D003937:Diagnosis, Differential; D005260:Female; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain; D019675:Genes, T-Cell Receptor gamma; D006801:Humans; D006965:Hyperplasia / Q000235:genetics / Q000382:microbiology / Q000473:pathology; D007150:Immunohistochemistry; D008193:Lyme Disease / Q000150:complications; D008223:Lymphoma / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000235:genetics / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009558:Nipples / Q000382:microbiology / Q000473:pathology*; D016133:Polymerase Chain Reaction; D019310:Pseudolymphoma / Q000235:genetics / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000235:genetics / Q000382:microbiology / Q000473:pathology*