title: A variant of lymphomatoid papulosis simulating primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma. Description of 9 cases.
abstract: Lymphomatoid papulosis (LyP) is a recurrent, self-healing eruption belonging to the spectrum of cutaneous CD30+lymphoproliferative disorders. Three main histologic subtypes of LyP are recognized: type A (histiocytic), type B (mycosis fungoides-(MF)-like), and type C (anaplastic large cell lymphoma-like). We reviewed 26 biopsies from 9 patients (M:F=6:3, median age: 29; mean age 27,2; age range 10 to 38) who presented with clinical features typical of LyP but with histopathologic aspects that resembled primary cutaneous aggressive epidermotropic CD8+cytotoxic T-cell lymphoma. In all but 1 case atypical lymphoid cells showed expression of CD30, and in 8 of 9 cases a T-cell cytotoxic phenotype could be observed (betaF1+, CD3+, CD4-, CD8+). Expression of at least 1 cytotoxic marker (TIA-1, granzyme B) was observed in all cases. Polymerase chain reaction analysis of the T-cell receptor genes revealed a monoclonal rearrangement in 2 of 5 cases tested. Follow-up data available for 8 patients (mean follow-up time: 84 mo, median: 32.5 mo; range: 1 to 303 mo) revealed that none of them developed systemic involvement or signs of other cutaneous lymphomas. This cytotoxic variant of LyP may be histopathologically indistinguishable from primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma, and may be the source of pitfalls in the diagnosis and classification. We propose the term LyP type D for this unusual variant of the disease. Accurate clinicopathologic correlation is required in this setting, with crucial implications regarding prognosis and management of patients.
authors.affiliation: Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saggini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gulia
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Argenyi
authors.forename: Regina
authors.initials: R
authors.lastname: Fink-Puches
authors.forename: Amelia
authors.initials: A
authors.lastname: Lissia
authors.forename: Mario
authors.initials: M
authors.lastname: Magaña
authors.forename: Luis
authors.initials: L
authors.lastname: Requena
authors.forename: Ingrid
authors.initials: I
authors.lastname: Simonitsch
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cerroni
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D019675:Genes, T-Cell Receptor gamma; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D017403:In Situ Hybridization; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000473:pathology / Q000821:virology; D017731:Lymphomatoid Papulosis / Q000145:classification / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology* / Q000473:pathology / Q000821:virology; D009626:Terminology as Topic; D055815:Young Adult
chemical_list: C099537:Epstein-Barr virus encoded RNA 1; D012367:RNA, Viral