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Messana K, Marburger T, Bergfeld W. EBV-Negative Cutaneous Lymphomatoid Granulomatosis With Concomitant EBV-Positive Pulmonary Involvement. Am J Dermatopathol 2015; 37:707-11. [DOI: 10.1097/dad.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thein M, Ravat F, Orchard G, Calonje E, Russell-Jones R. Syringotropic cutaneous T-cell lymphoma: an immunophenotypic and genotypic study of five cases. Br J Dermatol 2004; 151:216-26. [PMID: 15270895 DOI: 10.1111/j.1365-2133.2004.06028.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is uncertainty about the exact nosological relationship between mycosis fungoides, follicular mucinosis, syringolymphoid hyperplasia with alopecia (SLHA) and syringotropic cutaneous T-cell lymphoma (CTCL). We report the clinical, histological, immunophenotypic and genotypic characteristics of a series of five patients (three men and two women) with syringotropic CTCL. We also review the 15 cases of SLHA previously reported in the literature. We conclude that syringotropic CTCL is a distinct clinicopathological variant of mycosis fungoides which may present on its own with characteristic punctate erythema or more commonly in association with folliculotropic lesions. Syringotropic CTCL is characterized histologically by infiltration of sweat glands by atypical lymphocytes in association with syringolymphoid hyperplasia. Cases of SLHA represent a syringotropic form of CTCL in association with follicular involvement, and such cases need to be investigated using T-cell receptor gene analysis of both skin and blood. Only limited conclusions on prognosis can be derived from our preliminary data. However, a review of the literature suggests that the prognosis does not differ significantly from other types of mycosis fungoides of equivalent stage.
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MESH Headings
- Adult
- Aged
- Female
- Gene Rearrangement, T-Lymphocyte
- Genotype
- Humans
- Immunophenotyping
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/radiotherapy
- Male
- Middle Aged
- Mycosis Fungoides/genetics
- Mycosis Fungoides/immunology
- Receptors, Antigen, T-Cell/analysis
- Receptors, Antigen, T-Cell/blood
- Skin/immunology
- Sweat Gland Neoplasms/genetics
- Sweat Gland Neoplasms/immunology
- Sweat Gland Neoplasms/radiotherapy
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Affiliation(s)
- M Thein
- Department of Dermatology, Ealing Hospital, Uxbridge Road, Southall, Middlesex UB1 3HW, UK.
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Abstract
Reaching a diagnosis or formulating a differential diagnosis in dermatopathology involves combining information from clinical and pathological sources. Traditionally, this process is presented as a chronologic progression from the patient's complaint, through the evaluation of findings, terminating in the microscopic examination of the biopsy specimen. However, dermatopathologists often find the sequence reversed. They must first form an impression of the diagnosis from the slide and then supplement it with clinical information. The purpose of this article is to present the spectrum of granulomatous dermatoses from a pathologic perspective. The dermatoses are categorized into five groups on the basis of histologic patterns.
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Affiliation(s)
- L O Rabinowitz
- Institute of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Huang CL, Kuo TT, Chan HL. Acquired generalized hypohidrosis/anhidrosis with subclinical Sjögren's syndrome: report of a case with diffuse syringolymphoid hyperplasia and lymphocytic sialadenitis. J Am Acad Dermatol 1996; 35:350-2. [PMID: 8698925 DOI: 10.1016/s0190-9622(96)90668-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The pathogenesis and the underlying pathologic changes of acquired generalized hypohidrosis/anhidrosis (AGHA) are largely unknown. We studied a case of AGHA in a young woman suffering from heat intolerance and progressive loss of sweating. Pathologic study of affected skin revealed unique syringolymphoid hyperplasia with T cell infiltration, suggesting a T cell-mediated autoimmune disease. The patient also had subclinical Sjögren's syndrome and diffuse hair loss. The pathogenesis of the latter two conditions is believed to be related to the patient's AGHA.
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Affiliation(s)
- C L Huang
- Department of Dermatology, Chang Gung College of Medicine and Technology, Kwei San, Tao Yuan, Taiwan
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Tomaszewski MM, Lupton GP, Krishnan J, Welch M, James WD. Syringolymphoid hyperplasia with alopecia. A case report. J Cutan Pathol 1994; 21:520-6. [PMID: 7699119 DOI: 10.1111/j.1600-0560.1994.tb00722.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Syringolymphoid hyperplasia with alopecia is an uncommon skin disorder described in 1969 by Sarkany. Since then only three additional cases have been reported, all in the European literature. We present a 59-year-old man with two persistent hyperpigmented hairless patches of 13 years duration. Biopsy specimens revealed characteristic hyperplastic changes of the eccrine glands and ducts and a dense lymphocytic infiltrate surrounding eccrine structures with "syringotropism". Perifollicular lymphocytic infiltration and changes consistent with follicular mucinosis and mycosis fungoides were also present. Imunophenotyping and gene rearrangement studies showed the cells to be primarily of the T helper phenotype with rearrangement of the surface receptor gene.
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Affiliation(s)
- M M Tomaszewski
- Department of Dermatopathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000
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Zelger B, Sepp N, Weyrer K, Grünewald K, Zelger B. Syringotropic cutaneous T-cell lymphoma: a variant of mycosis fungoides? Br J Dermatol 1994; 130:765-9. [PMID: 8011503 DOI: 10.1111/j.1365-2133.1994.tb03415.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report two patients with the typical clinical (patches/plaques studded with brownish-red papules) and histopathological (hyperplastic eccrine ducts and glands surrounded and infiltrated by lymphocytes) features of syringotropic cutaneous T-cell lymphoma. Immunohistochemical studies confirmed the T-cell character of the infiltrate, and gene rearrangement studies its monoclonality (in one case). Our patients did not present with visceral involvement.
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Affiliation(s)
- B Zelger
- Department of Dermatology, University of Innsbruck, Austria
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Affiliation(s)
- C M Magro
- Department of Pathology, Beth Israel Hospital, Harvard Medical School, Cambridge, Massachusetts
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MAGRO CYNTHIAM, TAWFIK NAJIH, CROWSON ANEIL. LYMPHOMATOID GRANULOMATOSIS. Int J Dermatol 1994. [DOI: 10.1111/j.1365-4362.1994.tb04938.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Torrelo A, Martín M, Rocamora A, Allegue F, Ledo A. Lymphomatoid granulomatosis presenting as angioedema. Postgrad Med J 1992; 68:366-8. [PMID: 1630983 PMCID: PMC2399400 DOI: 10.1136/pgmj.68.799.366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe a patient with severe eyelid and lip angioedema lesions in whom biopsy specimens from angioedematous labial mucosa disclosed features of lymphomatoid granulomatosis. To our knowledge, angioedema lesions with characteristic histological findings of lymphomatoid granulomatosis have not been previously described as a presenting sign of this disease.
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Affiliation(s)
- A Torrelo
- Dermatology Department, Hospital Ramón y Cajal, Madrid, Spain
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Abstract
A 59-year-old woman with lymphomatoid granulomatosis (LYG) involving the lungs and skin is reported. This patient had many large, ulcerated cutaneous lesions that progressed during prednisone and cyclophosphamide therapy. However, the cutaneous disease responded to radiation treatment in terms of relief of symptoms and objective evidence of subsidence of local disease. The patient died of an unrelated cause 2 years after the establishment of the diagnosis of LYG. At autopsy, the skin lesions were completely healed, with no residual disease. However, there was evidence of the progression of LYG into a malignant large cell lymphoma involving the liver and lung. A discussion of the nature of LYG and the role of radiotherapy in localized disease is presented.
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Affiliation(s)
- B D Nair
- Ottawa Regional Cancer Centre, Civic Hospital Division, Ontario, Canada
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Abstract
The clinical and pathologic appearance of seven patients with lymphomatoid granulomatosis who had skin lesions when first seen is reviewed. Six patients subsequently developed systemic disease. Although the gross morphology of the skin lesions is variable, the pathology is distinctive. An adequate deep biopsy shows the characteristic lymphohistiocytic infiltrate with variable numbers of atypical cells. Angiodestruction is less evident in the skin compared to other organs. The infiltrate surrounds and invades not only vessels but also nerves and epidermal appendages. The skin biopsy specimen can be differentiated from the lymphomatous infiltrates and Wegener's granulomatosis. Two of the patients who developed systemic disease were diagnosed by skin biopsy but clinicians failed to institute therapy, preferring to wait for other organ involvement. In addition, two patients developed lymphoma, one of which was confirmed at autopsy and one on subcutaneous and bone marrow biopsy 5 years after the initial skin diagnosis. Lymphomatoid granulomatosis can be diagnosed by performing a skin biopsy. Appropriate chemotherapy may result in a high percentage of complete remissions and therefore the dermatopathologist can play an important role in the early diagnosis of this potentially fatal disease.
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Affiliation(s)
- J Jambrosic
- Department of Pathology, Women's College Hospital, Toronto, Ontario, Canada
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Gibson LE, Winkelmann RK. Cutaneous granulomatous vasculitis: its relationship to systemic disease. J Am Acad Dermatol 1986; 14:492-501. [PMID: 3958262 DOI: 10.1016/s0190-9622(86)70064-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Microscopic and medical review of twenty-six patients with skin biopsy specimens that showed granulomatous vasculitis demonstrated vascular histiocytic granulomas with fibrinoid destruction of blood vessels in the dermis and panniculus. Cultures of the biopsy specimens were nonspecific. The skin lesions varied from erythema to papulonodular and vesicular eruptions; they were usually on the extremities but also involved the trunk. Eight patients had systemic lymphoproliferative diseases: three, lymphoma; two, angioimmunoblastic lymphadenopathy; two, preleukemia; and one, chronic granulocytic leukemia. Five of these eight patients died within 2 years after the onset of skin lesions. The four patients with systemic vasculitis died within 1 year after the onset of skin lesions. Five patients with arthritis, four with gastrointestinal disease, three with systemic sarcoidosis or sarcoidlike disease, and one with tuberculosis had a more favorable prognosis. The histologic pattern of cutaneous nonlymphomatoid granulomatous vasculitis is associated with significant systemic disease, especially lymphoproliferative disorders. Patients with lymphoproliferative disorders or systemic vasculitis have a much poorer prognosis than those with inflammatory or infectious granulomatous disease.
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Wood ML, Harrington CI, Slater DN, Rooney N, Clark A. Cutaneous lymphomatoid granulomatosis: a rare cause of recurrent skin ulceration. Br J Dermatol 1984; 110:619-25. [PMID: 6232940 DOI: 10.1111/j.1365-2133.1984.tb04688.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We report the case of a 34-year-old male who presented with recurrent skin ulceration due to lymphomatoid granulomatosis. Monoclonal antibody studies showed a high T helper (T4):T suppressor (T8) cell ratio in both the lesions and the peripheral blood. Plasma cells in the infiltrate showed IgA lambda staining but as yet no monoclonal immunoglobulin has been identified in the blood or urine. Lymphocytes bearing markers of immature cells (T10) were observed in the tissue and blood.
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Abstract
A 26-year-old man presented with an unusual skin lesion consisting of a hairless area on the left leg studded with reddish-brown papules, together with follicular hyperkeratosis and circumscribed anhidrosis. Skin biopsies showed dense lymphocytic infiltrates in the dermis and around hyperplastic sweat ducts and glands. Similar clinical and histological features have been described in two previous case reports. We propose the term syringolymphoid hyperplasia with alopecia for this unusual skin disease.
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Harrington C, Wood M, Rooney N, Clark T, Maddocks J, Slater D. Lymphomatoid granulomatosis. BMJ : BRITISH MEDICAL JOURNAL 1983; 286:1749. [PMID: 6405966 PMCID: PMC1548245 DOI: 10.1136/bmj.286.6379.1749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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MacDonald DM. Histopathological differentiation of benign and malignant cutaneous lymphocytic infiltrates. Br J Dermatol 1982; 107:715-8. [PMID: 6983364 DOI: 10.1111/j.1365-2133.1982.tb00535.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Two female patients with lymphomatoid granulomatosis have received radiation therapy for local, progressive, symptomatic lesions. One patient was a 56-year-old woman with concomitant brain and pulmonary lesions which progressed on cyclophosphamide and prednisone therapy. The second patient was a 62-year-old woman with a supraorbital mass which appeared and progressed on prednisone therapy. Both patients exhibited rapid response to radiation therapy, in terms of relief of symptoms and objective evidence of subsidence of local disease. A discussion of the nature of lymphomatoid granulomatosis and its treatment is presented with a review of the literature. One hundred sixty-five cases have now been described including the two in this study, and in only one previous case was radiation therapy utilized to treat local disease, prior to the two cases described herein.
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Abstract
A 24 year old man had a nonproductive cough and chest pain. Chest roentgenogram showed a diffuse infiltrate, and pulmonary function studies showed restrictive lung disease. Extremity weakness, deteriorating mental status and neuropathy progressed as pulmonary findings diminished on corticosteroid therapy. Lung biopsy showed lymphomatoid granulomatosis. The neurologic status deteriorated despite treatment with Cytoxan, intrathecal methotrexate and brain irradiation. Autopsy showed mass lesions of lymphomatoid granulomatosis in the brain and healed lesions in the lungs. A review of the neurologic and pulmonary findings in reported cases show that diminution of pulmonary disease with progression of neurologic disease manifest by mass lesion is unusual. Since the etiology, prognosis and prevalence of this disease remains undefined, all patients with this disease should be reported on.
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