CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 May;178(5):353-6

DOI: 10.23736/S0393-3660.18.03760-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lymphomatoid papulosis mimicking cutaneous histiocytosis

Abbas DARJANI ¹, Seyyede ZEINAB AZIMI ¹ ✉, Seyed ALIREZA MESBAH ¹, Rana RAFIEI ¹, Kaveh GHARAEI NEJAD ¹, Behnam RAFIEE ²

¹ Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; ² Department of Pathology, NYU Winthrop Hospital, Mineola, NY, USA

Lymphomatoid papulosis (LyP) is a primary cutaneous CD30-positive T-cell lymphoproliferative disorder that is clinically characterized by a chronic, recurrent and regressing eruption. We report a case of LyP with numerous skin lesions, previously diagnosed as cutaneous histiocytosis. A 41-year-old Caucasian male presented with a 6-year history of gradual onset of purple papules and nodules symmetrically distributed predominantly on the trunk, extremities and face. Due to clinical and histopathological features, suggestive of scabies and histiocytic disorders, he was treated respectively with permethrin 5% cream and PUVA therapy which were not effective. One year later another episode of numerous skin lesions happened and this time new histopathologic findings were compatible with LyP (type A) which were confirmed with Immunohistochemistry [positive for CD30, CD3, CD5, CD43 and negative for ALK (anaplastic lymphoma kinase), CD68, CD20, CD99 and AE1/AE3]. He responded dramatically to intramuscular methotrexate 10mg weekly. Immunohistologic findings in our case were in favor of a CD30+ cutaneous T-cell lymphoma. Although the cells with classic histiocytoid appearance were present initially, immunostaining evaluation in later skin biopsy revealed that these cells were T-cell lymphocytes. We presented this histiocytoid cell-rich variant of LyP (type A) to emphasize that lymphoid infiltrations could imitate histiocytic lesion and in this way prevent misdiagnosis.

KEY WORDS: Lymphoproliferative disorders - Lymphomatoid papulosis - Neoplasms by histologic type