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Skin - Nonmelanocytic tumors

Lymphoma and related disorders

Lymphomatoid papulosis

Reviewer: Christopher Hale, M.D. (see Reviewers page)
Revised: 15 July 2012, last major update June 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Rare, self-healing, recurrent papular eruption
● Indolent clinical course, although 10% are associated with or evolve to anaplastic large cell lymphoma
● May be self healing “benign” phase of anaplastic large cell lymphoma (per Rosai)
● May resemble pityriasis lichenoides et varioliformis acuta, or have large ulcerated plaques and nodules

Case reports
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● 66 year old man with erythematous nodule on forearm (CMAJ 2012;184:917)

Treatment
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● Regular follow-up

Clinical images
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Erythematous nodule on the forearm of a 66 year old man

Micro description
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● Wedge shaped on low power with base of lymphocytes at epidermis and tip deep within reticular dermis
● Polymorphic superficial dermal infiltrate, usually perivascular, with thin epidermis
● Occasional atypical lymphoid cells resembling Reed-Sternberg cells or “lumps of coal”
● Often obscures dermoepidermal junction with variable epidermotropism

Type A:
● Pleomorphic CD30+ lymphocytes with hyperchromatic nuclei that may mimic Reed-Sternberg cells
● Also mixed inflammatory infiltrate
● CD3+, CD4+, CD8-, CD20-, CD30+, CD56-

Type B:
● Relatively small hyperchromatic lymphocytes with complex nuclear membranes
● CD3+, CD4+, CD8-, CD20-, CD30-, CD56-

Micro images
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Type A - contributed by Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain


CD30

Molecular
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● T cells are clonal, but this doesn’t predict transformation to lymphoma

Differential diagnosis
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● Arthropod bite

Additional references
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● Am J Dermatopathol 2012 Jun 8 [Epub ahead of print]

End of Skin - Nonmelanocytic tumors > Lymphoma and related disorders > Lymphomatoid papulosis

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