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SH/EAHP Workshop 2011 Los Angeles, California, USA

October 27-29, 2011

Session 6

Reactive Lymphoproliferations of the skin

Rein Willemze

Session Summary

Summary session 6

October 27-29 2011, Los Angeles, CA, USA

• Atypical T-cell infiltrates (lymphomatoid; pseudo-T-cell lymphoma; PCSM-TCL).

• Atypical B-cell infiltrates (CLH; pseudo-B-cell lymphoma).

• Reactive conditions mimicking C-ALCL/LyP • (Lupus) panniculitis • Special cases

Another four cases

Session 6 - case 211

October 27-29 2011, Los Angeles, CA, USA

Submitted by Gulsah Kaygusuz and Isinsu Kuzu

Ankara University, School of Medicine, Dept. of Pathology, Turkey

• 21 years old, female

• presented with subcutaneous, nodular lesion on

right temporal region of the scalp for 2 months.

H&E

H&E

CD20 CD3 Bcl-6

Ki-67 CD21 Bcl-2

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Session 6 - case 211

October 27-29 2011, Los Angeles, CA, USA

Submitted by Gulsah Kaygusuz and Isinsu Kuzu

Ankara University, School of Medicine, Dept. of Pathology, Turkey

Panel diagnosis:

Reactive follicular hyperplasia due to bloodsucker

(Annelida, Hirudinea) application.

Multiple pseudolymphomas caused by Hirudo medicinalis therapy

Smolle J. et al. J Am Acad Dermatol 43,867,2000

Multiple pseudolymphomas caused by Hirudo medicinalis therapy

Smolle J. et al. J Am Acad Dermatol 43,867,2000

Cutaneous Lymphoid hyperplasia

October 27-29 2011, Los Angeles, CA, USA

Etiology:

• Tick bites (Borrelia burgdorferi infection)

• Tattoo pigments

• Antigen injections; piercings; golden earrings, etc.

• Unknown

In common: intradermal antigens bypassing epidermal LC network.

Synonyms: • Pseudo-B-cell lymphoma • Lymphadenosis benigna cutis • Lymphocytoma cutis • Sarcoid of Spiegler-Fendt

CLH – tick bite - tattoo

October 27-29 2011, Los Angeles, CA, USA

Session 6 - case 91

October 27-29 2011, Los Angeles, CA, USA

Submitted by Erick Jacobson-Dunlop, MD et al.

Depts. of Dermatology and Pathology, Oregon Health and Science University

as

Scabies Bite Reaction Mimicking LyP

• A 51-year-old woman presenting with

• a two month history of pruritic lesions

on her arms and trunk.

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CD3

CD20

CD30 CD8 CD4

Session 6 - case 91

October 27-29 2011, Los Angeles, CA, USA

Submitted by Erick Jacobson-Dunlop, MD et al.

Depts. of Dermatology and Pathology, Oregon Health and Science University

Panel diagnosis:

Scabies Bite Reaction

Benign cutaneous CD30+ conditions

MUC

LMUC

L

Viral infection:

– molluscum contagiosum

– Orf; milker’s nodule

– Herpes virus infection

– HPV

– HIV

• Parasite infections (scabies)

• Atopic dermatitis

• Insect bites, patch tests, etc.

• Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE).

Session 6 - case 303

October 27-29 2011, Los Angeles, CA, USA

Submitted by Patty Jansen and Rein Willemze

Depts. of Pathology and Dermatology, LUMC, Leiden, The Netherlands

Clinical History:

21-year-old female with an ulcerative lesion

on mucosa upper lip since one week.

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CD3 CD4 CD8 CD5

CD30 Ki-67 CD68

CD30

CD3 CD4

TIA-1

CD8

CD5

Ki-67

Case 303 – main findings

October 27-29 2011, Los Angeles, CA, USA

• Ulcerative lesion of oral mucosa. • Atypical T-cell infiltrate of medium-sized to large

blast cells, admixed with small lymphocytes, histiocytes and eosinophils.

• Phenotype: CD30+/-, CD2+, CD3+, CD4+, CD5-, CD8-, CD56-, TIA-1+, GrB-.

• EBER: negative • Clonal TCR gene rearrangement. • Staging negative.

Case 303 – main findings

October 27-29 2011, Los Angeles, CA, USA

Differential diagnosis: • Counterpart spectrum cutaneous CD30+ LPD • TUGSE

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Session 6 - case 303

October 27-29 2011, Los Angeles, CA, USA

Submitted by Patty Jansen and Rein Willemze

Depts. of Pathology and Dermatology, LUMC, Leiden, The Netherlands

Panel diagnosis:

Traumatic Ulcerative Granuloma with

Stromal Eosinophilia of the oral cavity

(TUGSE)

Case 303 – TUGSE

October 27-29 2011, Los Angeles, CA, USA

• Ulcerative lesion of oral mucosa (tongue). • Self-limiting; rapid regression (after biopsy). • DD clinically: SCC; lymphoma; syphilis !! • CD30+ large atypical cells (50%) • Stromal eosinophilia • May be clonal (25%)

Session 6 - case 159

October 27-29 2011, Los Angeles, CA, USA

Submitted by Seble Chekol, MD and Nahid Nanaji MD

Dept. of Pathology, University of Maryland Medical Center, Baltimore

as

Cutaneous anaplastic large cell lymphoma (ALK negative)

• 83-year-old female with an ulcerative lesion on her lower lip.

• Previously biopsied and diagnosed as poorly differentiated SCC.

• Examination: exophytic mass on the lower lip.

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CD45

CD30 ALK

CD3

Session 6 - case 159

October 27-29 2011, Los Angeles, CA, USA

Submitted by Seble Chekol, MD and Nahid Nanaji MD

Dept. of Pathology, University of Maryland Medical Center, Baltimore

Panel diagnosis:

Traumatic Ulcerative Granuloma with

Stromal Eosinophilia of the oral cavity

(TUGSE)