Solitary small- to medium-sized pleomorphic T-cell nodules of undetermined significance: clinical, histopathological, immunohistochemical and molecular analysis of 26 cases.
BACKGROUND
Solitary skin nodules composed of pleomorphic T lymphocytes are often the source of diagnostic problems.


OBJECTIVE
To characterize the clinicopathological features, prognosis and optimal treatment modalities of patients with solitary lymphoid nodules of small- to medium-sized pleomorphic T lymphocytes.


METHODS
Twenty-six patients were analysed for clinical, histopathological, immunophenotypical, molecular and follow-up data.


RESULTS
Lesions were located mainly on the head and neck (n = 16; 61.5%) or trunk (n = 8; 30.8%). Histopathology showed non-epidermotropic nodular or diffuse infiltrates of small- to medium-sized pleomorphic T lymphocytes. Monoclonality was found by PCR in 54.2% of cases (n = 13/24). After a mean follow-up of 79.7 months, a local recurrence could be observed only in 1 patient.


CONCLUSIONS
Our patients have a specific cutaneous lymphoproliferative disorder characterized by reproducible clinicopathological features. The incongruity between the indolent clinical course and the worrying histopathological features poses difficulties in classifying these cases unambiguously as benign or malignant. We suggest to describe these lesions as 'solitary small- to medium-sized pleomorphic T-cell nodules of undetermined significance'. Irrespective of the name given to these equivocal cutaneous lymphoid proliferations, follow-up data support a non-aggressive therapeutic strategy.
Department of Dermatology, Medical University of Graz, Graz, Austria.
Bernd
B
Leinweber
Helmut
H
Beltraminelli
Helmut
H
Kerl
Lorenzo
L
Cerroni
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D005260:Female; D019675:Genes, T-Cell Receptor gamma; D006801:Humans; D007150:Immunohistochemistry; D016131:Lymphocyte Subsets; D016410:Lymphoma, T-Cell, Cutaneous / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology*; D013601:T-Lymphocytes / Q000473:pathology*; D055815:Young Adult