History: Frederic Woringer (1903-1964) and Woringer-Kolopp disease

Dermatopathology in Strasbourg during the German Occupation (1940-1945)

INTRODUCTION

The activity of the Strasbourg Dermatology Clinic was interrupted in September 1939 by the outbreak of the Second World War and the evacuation of the hospital. After annexing Alsace to the Reich, the German authorities demanded that physicians return to work, which resumed at the Dermatology Clinic, and was now entirely Germanized, in particular the laboratory of dermatopathology. Our aim was to study activity in the histopathology laboratory between 1939 and 1945.

MATERIAL AND METHODS

We studied all the histopathology reports contained in three registers written in German. We collected patient data, clinical elements and diagnoses by microscopy. There were a total of 1202 cases between September 1940 and March 1945. The records were in a good state of preservation, enabling exhaustive analysis.

RESULTS

The number of cases peaked in 1941 and diminished thereafter. The average age of patients was 49 years, and the sex ratio was 0.77. Patients were referred from Alsace or other Reich territories; referrals from other regions of France or other countries had ceased. There were 655 cases in dermatopathology, with a predominance of tumor lesions, followed by infections and inflammatory dermatoses. We noted 547 cases of non-cutaneous diseases, mainly in gynecology, urology, and in ear, nose, throat and digestive surgery; their numbers peaked in 1940-41, then tapered off progressively.

DISCUSSION

Thedisruptions associated with thewar were manifested by the use of German language and the cessation of scientific publications. The lack of general pathologists in the hospital resulted in numerous cases in general pathology. Skin biopsies were mainly diagnostic and focused on skin cancers, whereas inflammatory and infectious diseases predominated before the war. No traces of data related to unethical human experimentation were identified in these archives, in contrast to other institutes in Strasbourg that were truly Nazified.

CONCLUSION

These data from the Strasbourg Dermatology Clinic contain valuable information for the history of medicine and provide an insight into the functioning of a laboratory under the Occupation.

Woringer-Kolopp Disease of the Foot: A Case Report

Woringer-Kolopp disease is a rare variant of mycosis fungoides, a type of cutaneous T-cell lymphoma. Described is a case of a small annular plaque on the foot diagnosed histologically as Woringer-Kolopp disease and treated successfully with topical and intralesional steroids. In addition, a brief review of the literature and treatment options is provided.

Pagetoid Reticulosis: Report of Two Cases and Review of the Literature

Pagetoid reticulosis is a rare variant of mycosis fungoides that presents with a large, usually single, erythematous, slowly growing scaly plaque containing an intraepidermal proliferation of neoplastic T lymphocytes. Histopathologically, this disease has distinctive attributes. In this report, we present two cases of pagetoid reticulosis, compare its microscopic features to those of ‘classical’ mycosis fungoides, and provide a brief review of the pertinent literature.

Pagetoid reticulosis in a 5-year-old boy

We present a rare case of pagetoid reticulosis arising in a 5-year-old white boy. He had a history of a large chronic erythematous, scaly patch on his left buttock that had shown intermittent partial response to a topical antifungal medication. A punch biopsy specimen revealed dramatic epidermal hyperplasia, with parakeratosis and prominent exocytosis of single and clustered mononuclear cells (Pautrier's microabscesses) into the epidermis. Some of these exhibited hyperchromatic nuclei with irregular contours. They stained prominently for CD3, CD4, and CD8, with a predominance of CD8(+) cells. T-cell receptor gene rearrangement by polymerase chain reaction was negative for a clonal process on a second biopsy specimen that was nondiagnostic on routine sections. Pagetoid reticulosis is an indolent, unilesional variant of mycosis fungoides, in which the atypical T cells may express a CD4(-)/CD8(+) phenotype. This is in contrast to primary cutaneous epidermotropic CD8(+) cytotoxic T-cell lymphoma, which is often very aggressive with a poor outcome. Pagetoid reticulosis is exceedingly rare in children and adolescents. Two features predict a benign course in this 5-year-old child: the unilesional clinical presentation and the CD8 predominance of the epidermal lymphocytes.

Epidermotropic Precursor T-cell Lymphoma With Highly Aggressive Clinical Behavior Simulating Localized Pagetoid Reticulosis

We describe a 43-year-old patient with a solitary, eczematous plaque on his right nipple that had developed during the previous 6 weeks. Histopathology revealed a superficial band-like infiltrate of medium to large-sized pleomorphic lymphocytes with striking epidermotropism. The tumor cells expressed a T-phenotype (CD3+, CD20-) and were CD30-, CD4-, and CD8-negative. A diagnosis of localized pagetoid reticulosis (Woringer-Kolopp disease) with possible large cell transformation was proposed. A cervical lymph node excised 2 months later showed features of a highly aggressive blastoid precursor T-cell lymphoma. Reevaluation of the skin lesion and of a tonsil specimen previously interpreted as benign hyperplasia showed features consistent with those observed in the lymph node. The disease was rapidly progressive, and the patient died 15 months after the first skin biopsy. This case represents a unique cutaneous presentation of aggressive precursor lymphoma, showing the protean nature of lymphoproliferative disorders and the overlapping clinical and histopathologic features of different entities.