B-cell infiltrates (CLH; pseudo-B- Session 6 Reactive .... Willemze su… · 14-11-2011 3 CD3 CD2 0...
Transcript of B-cell infiltrates (CLH; pseudo-B- Session 6 Reactive .... Willemze su… · 14-11-2011 3 CD3 CD2 0...
14-11-2011
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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)