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Hernani D. Cualing - Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin

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Book:
Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin
Author:
Hernani D Cualing / Marshall E Kadin / Mai P Hoang / Michael B Morgan
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Springer
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Year:
2014
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Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin: summary, description and annotation

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This volume explores the nexus of manifestations of hematopathology and dermatopathology and provides a novel compartmental(epidermal, dermal, subcutaneous) -based framework to approach a diagnosis that considers both pseudolymphomatous and lymphomatous patterns. Through photographs, tables, and text, the book illustrates the range of non-neoplastic hematologic disorders and their neoplastic counterparts in skin: reactive patterns of infectious etiology and immune responses that simulate cutaneous lymphomas. The epidemiology, pathobiology, clinical and immuno-histopathologic manifestations in skin as well as the approach to diagnosis, selection and algorithmic interpretation of tests, and prognosis are also described. Written by experts in the field, Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin is a comprehensive resource that is of great value to surgical pathologists, hematopathologists, dermatopathologists, residents and fellows, community dermatologists, oncologists and infectious disease practitioners.

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Part I
Introduction to Hematopathology of Skin Infiltrates

Springer Science+Business Media New York 2014

Hernani D. Cualing , Marshall E. Kadin , Mai P. Hoang and Michael B. Morgan (eds.) Cutaneous Hematopathology 10.1007/978-1-4939-0950-6_1

1. Patterns of Lymphohistiocytic Reaction in Skin: An Approach to Cutaneous Lymphohematopoietic Infiltrate Using Histologic Patterns and Immunostains

Hernani D. Cualing 1 and Marshall E. Kadin 2

(1)

Department of Hematopathology and Cutaneous Lymphoma, IHCFLOW Diagnostic Laboratory, 18804 Chaville Rd, Lutz, FL 33558, USA

(2)

Department of Dermatology, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI, USA

Hernani D. Cualing

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Introduction

It is helpful to think of cutaneous lymphomas in the context of their relationship to normal skin structures. Here, we proffer an approach using guidelines based on the usual patterns seen in reactive histology of skin with lymphocytic and histiocytic reactions. There is increasing evidence that neoplastic histomorphologic patterns are superimposed on normal physiologic patterns. See on this evidence. Morphologic and immunophenotypic reactions show a relatively consistent pattern.

Many advances have been made through the cooperation of international medical groups, such as the European Organization for Research and Treatment of Cancer (EORTC) and the World Health Organization (WHO), and their joint classification of primary cutaneous lymphomas (Willemze et al. ). Thanks to this excellent effort by these dedicated groups, a common language is now spoken by dermatopathologists, hematopathologists, and clinicians in diagnosing and treating cutaneous lymphomas. Continuous progress especially in the application of molecular pathology brought forth new information and facilitated better understanding, not only of neoplastic but also of nonneoplastic cutaneous lymphoid infiltrates. Foremost is the recognition that cutaneous lymphomas are different from the similarly named nodal or systemic lymphomas and have to be approached and treated differently.

Table 1.1

Overview of nonneoplastic and neoplastic cutaneous lymphohematopoietic infiltrates

Nonneoplastic	Neoplastic
Reactive epidermotropic and lichenoid dermatitis	Cutaneous T-cell and NK-cell lymphomas
Langerhans cell hyperplastic vesicles, SD	Mycosis fungoides (MF)
Epidermotropic T-cell pseudolymphomas	MF variants and subtypes
Pseudolymphomatous folliculitis/idiopathic FM	Folliculotropic MF
Spongiotic dermatitides (SD)/lymphomatoid keratosis	Pagetoid reticulosis
Benign granulomatous dermatitis/dyscrasia	Granulomatous slack skin
Inflammatory vitiligo/hypopigmented T-cell dyscrasia	Hypopigmented MF
Syringolymphoid T-cell hyperplasia/dyscrasia	Syringolymphoid MF
Benign erythroderma/T-cell lymphocytosis of uncertain significance	Szary syndrome
Benign lymphocytosis/ T-cell pseudolymphomas	Adult T-cell leukemia/lymphoma
CD30 pseudolymphomas	Cutaneous CD30+ lymphoproliferative disorders
Nonclonal regressing histiocytosis	Anaplastic large cell lymphoma
Scabies, other CD30(+) infections, PLEVA	Lymphomatoid papulosis
Lupus profundus and other reactive panniculitis	Subcutaneous panniculitis-like T-cell lymphoma (SPCTL)
Reactive drug-induced/idiopathic vasculitis	Extranodal NK/T-cell lymphoma, nasal type
Nodular T-cell pseudolymphomas	Cutaneous peripheral T-cell lymphoma (large cell), unspecified
Pityriasis lichenoides et varioliformis acuta (PLEVA) and chronica (PLC)	Cutaneous aggressive epidermotropic CD8+ T-cell lymphoma
Spongiosis and reactive panniculitis	Cutaneous / T-cell lymphoma
Solitary T-cell nodules uncertain significance	Cutaneous small-/medium-sized lymphomas (CD8, CD4 )
Germinal center hyperplasia	Cutaneous B-cell lymphomas
Cutaneous B-cell lymphoid hyperplasia	Primary cutaneous marginal zone B-cell lymphoma
(B-cell pseudolymphomas)	Primary cutaneous follicle center lymphoma
Drug-induced hyperplasia (i.e., phenytoin)	Primary cutaneous diffuse large B-cell lymphoma, leg type
Solitary B-cell pseudolymphomas	Primary cutaneous diffuse large B-cell lymphoma, others
Granulomatous dermatitis	Lymphomatoid granulomatosis
Cutaneous IgG4 plasmacytosis	Plasmacytoma
Intravascular (intralymphatic) histiocytosis	Intravascular lymphoma
Sinus histiocytosis with massive lymphadenopathy	Hodgkin lymphoma
Langerhans cell hyperplasia	Langerhans cell histiocytosis
Immature extramedullary hematopoiesis	Cutaneous plasmacytoid dendritic leukemia
Cutaneous granulocytic sarcoma
Mastocytosis/Mast cell sarcoma
Lymphoblastic T- or B-cell lymphoma

FM follicular mucinosis

Extranodal lymphomas, especially those arising from the most visible organ, i.e., the skin, present, for the most part a different biology, pathogenesis, and, for the common types, a better response to therapy. In addition, access to skin lesions is relatively easy compared to nodal and other systemic lesions. Hence, work-up of a suspected lump or growth almost always involves a biopsy. The histology may be nonlymphoid or a lymphohematopoietic process. Rarely, the monomorphic infiltrate can resemble lymphoma though upon further comprehensive analysis it is discovered to be a poorly differentiated sarcoma, leukemia, carcinoma, or melanoma.

Hence, this book addresses the issue of approaching a biopsy with an open viewpoint that the lesion confronted could be lymphoid or nonlymphoid, neoplastic, dysplastic (but not frankly neoplastic), or reactive in nature. The first step in analyzing the biopsy begins with the microscope. Because most books in this subject organize the topics into known diseases or lymphoproliferations, we chose to differ in proffering an approach based on morphologic patterns . In this way, the microscopic findings provide the point of departure to seek the most precise diagnosis based first on tissue patterns, then on cytomorphology, immunophenotypic results, and when necessary molecular genetic analysis. Furthermore, we subscribe to the state-of-the-art cutaneous lymphoma consensus classifications and atypical lymphoproliferations (Cerroni et al. for the overview of benign and malignant cutaneous lymphohematopoietic infiltrates listing topics covered in this book.

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