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The differential diagnosis of CD8-positive (“type D”) lymphomatoid papulosis

Authors


  • This study was presented at the 48th American Society of Dermatopathology annual meeting, 2011, held in Seattle, WA, where it won First Prize Award among oral presentations.

Abstract

Background

Cutaneous CD8+ CD30+ lymphoproliferative lesions are difficult to classify and encompass entities that follow a benign course to overt lymphoma. In order to identify histopathologic criteria for lesions in this spectrum, a series of such cases was reviewed.

Methods

Twenty-eight biopsies from 27 patients with CD8+ CD30+ cutaneous lymphoid proliferations were evaluated.

Results

Seventeen cases were classified as lymphomatoid papulosis (LyP) ‘type D’, eight as cutaneous anaplastic large cell lymphoma (C-ALCL) and two as CD8+ mycosis fungoides (MF) with CD30 expression. Features of LyP included spongiosis and/or parakeratosis (90%), epidermotropism by large lymphocytes (90%), with (80%) or without (10%) small lymphocytes; wedge-shaped infiltrate (70%) with perivascular (100%) and interstitial (80%) pattern; and relative uniformity of CD30+ large atypical cells (90%). C-ALCL was characterized by ulceration (63%), epidermotropism restricted to small lymphocytes (100%), marked density (63%) and pleomorphism (62%) of CD30+ large atypical cells, and at least focal extension of infiltrate to subcutaneous tissue (88%). CD8+ CD30+ MF had vacuolar interface change and a lichenoid pattern (100%).

Conclusions

We concur with previous authors that distinction of CD8+ LyP from lymphoma in its differential diagnosis is difficult based on histopathology alone. Nonetheless, we propose that certain histopathologic clues may be helpful in this differential diagnosis.

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