title: The differential diagnosis of CD8-positive ("type D") lymphomatoid papulosis.
abstract: BACKGROUND
  Cutaneous CD8(+) CD30(+) lymphoproliferative lesions are difficult to classify and encompass entities that follow a benign course to overt lymphoma. In order to identify histopathologic criteria for lesions in this spectrum, a series of such cases was reviewed.
  
  
  METHODS
  Twenty-eight biopsies from 27 patients with CD8(+) CD30(+) cutaneous lymphoid proliferations were evaluated.
  
  
  RESULTS
  Seventeen cases were classified as lymphomatoid papulosis (LyP) 'type D', eight as cutaneous anaplastic large cell lymphoma (C-ALCL) and two as CD8(+) mycosis fungoides (MF) with CD30 expression. Features of LyP included spongiosis and/or parakeratosis (90%), epidermotropism by large lymphocytes (90%), with (80%) or without (10%) small lymphocytes; wedge-shaped infiltrate (70%) with perivascular (100%) and interstitial (80%) pattern; and relative uniformity of CD30(+) large atypical cells (90%). C-ALCL was characterized by ulceration (63%), epidermotropism restricted to small lymphocytes (100%), marked density (63%) and pleomorphism (62%) of CD30(+) large atypical cells, and at least focal extension of infiltrate to subcutaneous tissue (88%). CD8(+) CD30(+) MF had vacuolar interface change and a lichenoid pattern (100%).
  
  
  CONCLUSIONS
  We concur with previous authors that distinction of CD8(+) LyP from lymphoma in its differential diagnosis is difficult based on histopathology alone. Nonetheless, we propose that certain histopathologic clues may be helpful in this differential diagnosis.
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McQuitty
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Curry
authors.forename: Michael T
authors.initials: MT
authors.lastname: Tetzlaff
authors.forename: Victor G
authors.initials: VG
authors.lastname: Prieto
authors.forename: Madeleine
authors.initials: M
authors.lastname: Duvic
authors.forename: Carlos
authors.initials: C
authors.lastname: Torres-Cabala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017730:Ki-1 Antigen / Q000378:metabolism*; D017731:Lymphomatoid Papulosis / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000378:metabolism / Q000473:pathology
chemical_list: D017730:Ki-1 Antigen
keywords: CD30-positive lymphoproliferative disorder; CD8; lymphomatoid papulosis; lymphoproliferative disease