Benign cutaneous lymphoid infiltrates

Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis

Most patients with erythema migrans, the pathognomonic rash of Lyme disease, do not recall a deer tick bite. The rash is classically 5 to 68 cm of annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%). Serologic testing is not indicated for patients with erythema migrans, because initially, the result is usually negative. Successful treatment of a patient with erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil. Patients with Lyme arthritis usually present with a mildly painful swollen knee. Patients with Lyme arthritis have markedly positive serology and can usually be successfully treated with 28 days of oral doxycycline or amoxicillin. Some patients may have persistent effusion despite 4 to 8 weeks of antibiotics and may need synovectomy. Persistent effusion is not due to persistent infection. Antibiotic therapy for more than 8 weeks for patients with Lyme disease is not indicated. Chronic Lyme disease due to antibiotic resistant infection has not been demonstrated.

Heavy multinodular cutaneous lymphoid infiltrates: clinicopathologic features and B-cell clonality

BACKGROUND

Criteria for distinguishing between cutaneous lymphoid hyperplasia (CLH) and low-grade B-cell lymphoma are not well defined. We examined the hypothesis that the presence of a clonal B-cell population in heavy multinodular lymphoid infiltrates correlates with clinical presentation and outcome.

METHODS

We identified 29 patients with skin lesions characterized histologically by a heavy dermal lymphocytic infiltrate with a multinodular architecture and extension into deep dermis and subcutaneous fat. Clonality was assessed immunophenotypically by light-chain restriction and also by analysis for IgH-gene rearrangement using PCR on DNA extracted from paraffin blocks.

RESULTS

Follow-up (mean 80 months; median 45 months) was obtained in all patients. Twenty-four patients (83%) presented with a solitary lesion: only four had solitary recurrences, and none developed multiple synchronous lesions or systemic B-cell lymphoma. However, 9/24 of these solitary lesions (38%) were clonal by light-chain restriction or IgH PCR; 5/29 patients (17%) presented with multiple recurrent lesions and continued to develop lesions during the period of follow-up; 3/5 patients (60%) with multiple lesions demonstrated a B-cell clone. No patient developed systemic B-cell lymphoma.

CONCLUSIONS

Heavy, multinodular cutaneous lymphoid infiltrates have an excellent prognosis. Multiple lesions at presentation are the best predictor of recurrent multiple lesions confined to the skin. The presence of a clonal B-cell population does not correlate with clinical presentation or histology, nor does it predict development of further lesions or systemic lymphoma.

Lymphoma versus pseudolymphoma of the skin: gene rearrangement study of 21 cases with clinicopathologic correlation

BACKGROUND

Diagnosis of cutaneous lymphoma in the absence of systemic lymphoma may be difficult. Reactive lymphoid lesions can mimic lymphoma clinically and histologically and have been designated pseudolymphomas.

OBJECTIVE

Our purpose was to analyze lymphoid gene rearrangements in cutaneous lymphoproliferative lesions and to correlate these findings with the histologic, immunophenotypic, and clinical profile.

METHODS

We examined 21 cases of lymphoproliferative lesions that developed in skin and performed molecular rearrangement analysis of T-cell receptor and immunoglobulin genes. We examined identical tissues by histologic and immunophenotypic criteria and conducted follow-up clinical evaluation of all patients.

RESULTS

Clonal rearrangements of immunoglobulin (seven cases) or T-cell receptor (two cases) gene were detected in 9 of 21 patients. No specific histologic or immunophenotypic feature was consistently associated with a clonal lymphoid gene rearrangement. Systemic lymphoma developed in one patient in whom a clonal rearrangement within the immunoglobulin gene was identified.

CONCLUSION

Gene rearrangement analysis may be helpful in differentiating primary cutaneous lymphoma from pseudolymphoma. The chronic clinical course of patients with clonal lymphoid gene rearrangements supports a lack of correlation between clonality and biologic aggressiveness.

Benign lymphocytic infiltrate of the skin: correlation of clinical and pathologic findings

In a retrospective study of 137 biopsy specimens of skin from 137 patients (69 men and 68 women) that had been obtained between 1972 and 1989 at our institution and that had perivascular and periappendageal lymphocytic infiltrates characteristic of those described as benign lymphocytic infiltrate (BLI), we determined the specificity of the histologic diagnosis and the correlation with clinical data. The final diagnoses, based on clinical and laboratory data and histologic findings, were BLI (59), possible BLI (7), lupus erythematosus (LE) (12), possible LE (7), procainamide-induced LE (1), insect bites (9), possible insect bites (3), polymorphous light eruption (4), lymphocytoma (4), urticaria (4), and indeterminate or miscellaneous diagnoses (27). BLI is a clinical and histologic syndrome that can be heterogeneous in origin. We recommend careful evaluation to exclude other disorders such as LE, polymorphous light eruption, lymphocytoma, and insect bites. Direct immunofluorescence microscopy and immunophenotypic studies may help distinguish BLI from LE.

A Spontaneously Regressing Pseudolymphoma in a Dog Resembling Pseudo-Hodgkin's Disease

Abstract- A case report of a dog with a lymphohistiocytic proliferative disorder of the skin, third eyelids and lymph nodes is presented. Skin biopsies showed a nodular to diffuse cellular proliferation of lymphohistiocytic cells with many cytological features of malignancy. Numerous Reed-Sternberg cells were present. The pathological diagnosis was malignant lymphoma with cytological features of Hodgkin's disease. The dog experienced a spontaneous remission which has lasted for over three years. Résumé- Le cas clinique d'un chien présentant un désordre prolifératif lymphohistiocytaire de la peau, des troisièmes paupières et des ganglions lymphatiques est présenté. Des biopsies de peau ont motré une prolifération de nature nodulaire à diffuse des cellules lymphohistiocytaires avec plusieurs caractères cytologiques de malignité. De nombreuses cellules de Reed-Sternberg étaient présentes. Le diagnostic histologique était celui d'un lymphome malin avec des signes cytologiques de maladie de Hodgkin. Le chien a presénté une rémission spontanée qui a duré plus de 3 ans. Zusammenfassung- Der Fallbericht eines Hundes mit einer lymphohistiozytären, proliferativen Erkrankung von Haut, Nickhäuten und Lymphknoten wird beschrieben. Die Untersuchung von Hautbiopsien erbrachte eine noduläre bis diffuse zelluläre Proliferation der lymphohistiozytären Zellen mit zahlreichen zytologischen Anzeichen für maligne Veränderungen. Zahlreiche Reed-Sternberg-Zellen traten auf. Die pathologische Diagnose lautete "malignes Lymphom mit zytologischen Merkmalen der Hodgkinschen Erkrankung". Es kam zu einer spontanen Remission, die sich über drei Jahre erstreckte. Resumen  Se describe un caso de una enfermedad linfohistiocítica proliferativa que afectaba a la piel, al tercer párpado y a los ganglios linfáticos. Las biopsias cutáneas mostraron una proliferación nodular a difusa de células linfoides con características de malignidad. Se apreciaban numerosas células de Reed-Sternberg. El diagnóstico histopatológico fue linfoma maligno con características citológicas de enfermedad de Hodgkin. El perro sufrió una remisión espontánea que duró más de tres años.