Subject(s)
Bites and Stings , Pseudolymphoma , Humans , Pseudolymphoma/diagnosis , Pseudolymphoma/etiology , Animals , Bites and Stings/complications , Leeches , Male , FemaleABSTRACT
Cutaneous pseudolymphomas are a wide group of diseases mimicking cutaneous lymphoma. They comprise several skin conditions with different etiopathogenesis, clinical-pathological features, and prognosis, which may occur in the absence of an identifiable trigger factor or after administration of medications or vaccinations, tattoos, infections, or arthropod bites. They present with different manifestations: from solitary to regionally clustered lesions, up to generalized distribution and, in rare cases, erythroderma. They persist variably, from weeks to years, and resolve spontaneously or after antibiotics, but may recur in some cases. CD30+ T-cell pseudolymphomas are characterized by the presence of large, activated lymphoid cells, generally in response to viral infections, arthropod assault reactions, and drug eruptions. Stenotrophomonas maltophilia is a ubiquitous Gram-negative bacillus responsible for opportunistic infections in immunocompromised patients. Infection of intact skin in immunocompetent patients is particularly rare. Here, we report a case of a man presenting an isolated nodule histopathologically mimicking a primary cutaneous CD30+ T-cell lymphoproliferative disorder.
Subject(s)
Gram-Negative Bacterial Infections , Lymphoproliferative Disorders , Pseudolymphoma , Skin Diseases, Bacterial , Humans , Male , Middle Aged , Diagnosis, Differential , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/pathology , Immunocompetence , Ki-1 Antigen/metabolism , Lymphoproliferative Disorders/pathology , Lymphoproliferative Disorders/microbiology , Lymphoproliferative Disorders/diagnosis , Pseudolymphoma/pathology , Pseudolymphoma/diagnosis , Pseudolymphoma/microbiology , Pseudolymphoma/immunology , Skin Diseases, Bacterial/pathology , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/microbiology , Skin Diseases, Bacterial/immunology , Stenotrophomonas maltophilia/isolation & purification , T-Lymphocytes/immunology , T-Lymphocytes/pathologyABSTRACT
BACKGROUND: Hepatic reactive lymphoid hyperplasia (RLH) is a rare benign lymphoproliferative lesion and a poorly understood disease. It is usually asymptomatic and incidental, but it is difficult to distinguish from hepatocellular carcinoma and metastatic liver tumor on imaging, and percutaneous biopsy is not sufficient to distinguish from low-grade malignant lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), making diagnosis difficult. CASE SUMMARY: A 69-year-old woman came to our hospital for reexamination of pulmonary nodules followed by liver occupation. The lesions showed "wash-in and wash-out" on contrast-enhanced ultrasonography and magnetic resonance imaging. Enhanced magnetic resonance also showed annular envelope enhancement and limited diffusion on the ADC map during the delay period. Imaging revealed metastatic liver cancer, and the patient underwent a partial hepatectomy. However, the final histopathological diagnosis was RLH. CONCLUSION: If small isolated nodules are found in the liver of middle-aged and elderly female patients with no risk factors for liver malignancy, when the enhanced imaging suggests "wash-in and wash-out", further focus should be placed on whether the enhanced imaging shows perinodular enhancement and whether the DWI shows limited diffusion in MRI, in order to emphasize the possibility of liver RLH diagnosis.
Subject(s)
Liver Neoplasms , Pseudolymphoma , Humans , Female , Aged , Pseudolymphoma/pathology , Pseudolymphoma/diagnostic imaging , Pseudolymphoma/diagnosis , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Magnetic Resonance Imaging , Liver/pathology , Liver/diagnostic imaging , Ultrasonography , Lymphoma, B-Cell, Marginal Zone/diagnostic imaging , Lymphoma, B-Cell, Marginal Zone/pathologyABSTRACT
Hepatic reactive lymphoid hyperplasia is an uncommon benign condition, often found incidentally as a solitary liver lesion. The chronic inflammatory reaction associated with autoimmune conditions and malignancies has been postulated as a possible aetiology. The diagnosis is challenging as it often mimics various malignancies radiologically and histologically, hence the diagnosis being made only after surgical resection. Lymphadenopathy is common with primary biliary cholangitis, though rarely reported with reactive lymphoid hyperplasia. We report a case of hepatic reactive lymphoid hyperplasia associated with portacaval lymphadenopathy in a patient with primary biliary cholangitis, diagnosed after surgical resection. We propose lesional biopsy be considered in patients with primary biliary cholangitis found to have a solitary lesion with supporting low-risk clinical and radiological features.
Subject(s)
Cholangitis , Liver Cirrhosis, Biliary , Liver Neoplasms , Lymphadenopathy , Pseudolymphoma , Humans , Pseudolymphoma/diagnosis , Pseudolymphoma/pathology , Liver Cirrhosis, Biliary/complications , Liver Cirrhosis, Biliary/diagnosis , Liver Neoplasms/diagnosisABSTRACT
A 70-year-old woman was referred to our hospital because of slight elevation of soluble interleukin-2 receptor (sIL-2R) and accumulation of 18F-fluorodeoxyglucose (FDG) in S8 of the liver on positron emission tomography. The mass was strongly suspected to be malignant because of contrast enhancement and enlargement in size of the mass, and suspicion of portal vein invasion. Hepatic S8 subsegmentectomy was performed for diagnostic and therapeutic purposes. Hematoxylin and eosin staining of the resected specimen showed small lymphocytes with no atypia and no formation of lymphoid follicles. Immunostaining showed CD3-positive cells in the interfollicular region and CD20-positive cells in the lymphoid follicles. Both CD10 and BCL-2 were negative in the follicular germinal center. CD138-positive plasma cells were observed and there was no light chain restriction. Based on polyclonal growth pattern of lymphocytes in the lymphoid follicles and interfollicular region, she was diagnosed with hepatic reactive lymphoid hyperplasia (RLH).Review of the English literature of hepatic RLH which referred to imaging findings yielded 23 cases, including this case. As a result, we suggest that liver biopsy should be performed for definitive diagnosis, when hepatic RLH is suspected by imaging findings and backgrounds.
Subject(s)
Pseudolymphoma , Female , Humans , Aged , Pseudolymphoma/diagnosis , Pseudolymphoma/surgery , Pseudolymphoma/pathology , Liver/diagnostic imaging , Liver/pathology , Lymphocytes/pathology , Hyperplasia/pathology , Diagnosis, DifferentialABSTRACT
BACKGROUND: Lyme disease after a tick bite often presents as erythema migrans, yet less frequent variants of this disease, such as Borrelia lymphocytoma, multiple erythema migrans and neuroborreliosis, are also seen occasionally. CASE PRESENTATION: We report a case of a tick-bitten child who first presented with an indistinct macular erythema around the left eye and a more distinct macular erythema on and around the left ear. The next day, she developed a facial palsy. INTERPRETATION: The case was interpreted as facial multiple erythema migrans and Borrelia lymphocytoma on the ear, followed by neuroborreliosis. The diagnosis of lymphocytoma was made from clinical findings and PCR of skin biopsy. She recovered quickly after intravenous ceftriaxone and is now healthy.
Subject(s)
Lyme Disease , Pseudolymphoma , Skin Diseases, Bacterial , Child , Female , Humans , Ear Diseases/etiology , Erythema Chronicum Migrans/etiology , Facial Dermatoses/etiology , Facial Paralysis/etiology , Lyme Neuroborreliosis/etiology , Pseudolymphoma/diagnosis , Tick Bites/complications , Lyme Disease/complications , Lyme Disease/diagnosis , Skin Diseases, Bacterial/diagnosisABSTRACT
Borrelial pseudolymphoma, more commonly known as Borrelia lymphocytoma and previously also as lymphadenosis benigna cutis, is a rare manifestation of Lyme borreliosis, which occurs nearly always in children after an infection caused by Borrelia afzelii; this pathogen is transmitted exclusively by the Ixodes ricinus tick in our region. The most common body locations of this lymphocytoma include the earlobe, scrotum, nipples and the areomamillary complex. Therefore, the case of our patient was unexpected and quite rare. The aim of this article is to point out the high incidence of Lyme disease and its atypical manifestations which can be cured without surgical intervention in most cases. The authors describe the case of a 58-year-old healthy female patient with a very rare manifestation of Lyme disease.
Subject(s)
Borrelia burgdorferi Group , Borrelia , Lyme Disease , Pseudolymphoma , Male , Child , Humans , Adult , Female , Middle Aged , Pseudolymphoma/diagnosis , Eyebrows/pathology , Lyme Disease/complications , Lyme Disease/diagnosis , Lyme Disease/epidemiologySubject(s)
Pseudolymphoma , Humans , Pseudolymphoma/chemically induced , Pseudolymphoma/diagnosis , Pseudolymphoma/pathology , Gold , Patch TestsABSTRACT
This report included three cases of lymphoproliferative disorders developing from the lacrimal caruncle. The first case was an 11-year-old boy with reactive lymphoid hyperplasia in the left lacrimal caruncle. The second case was an 80-year-old woman with reactive lymphoid hyperplasia in the right lacrimal caruncle. The third case was a 77-year-old man with follicular lymphoma in the left lacrimal caruncle. Our literature review of cases with lacrimal caruncular lesions showed 11 reported cases with reactive lymphoid hyperplasia and 17 with malignant lymphoma. There had been no previous report on follicular lymphoma in the lacrimal caruncle.
Subject(s)
Lacrimal Apparatus Diseases , Lymphoma, Follicular , Lymphoproliferative Disorders , Pseudolymphoma , Male , Female , Humans , Aged, 80 and over , Child , Aged , Lacrimal Apparatus Diseases/diagnostic imaging , Lacrimal Apparatus Diseases/surgery , Lacrimal Apparatus Diseases/pathology , Pseudolymphoma/diagnosis , Pseudolymphoma/surgery , Conjunctiva/pathology , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/surgeryABSTRACT
BACKGROUND: Pseudolymphoma is a rare, benign, nonspecific condition that forms a mass-like lesion characterized by the proliferation of non-neoplastic lymphocytes. Lacking of specific clinical symptoms, serological markers, and imaging features, the diagnosis is difficult. We reporte five cases of hepatic pseudolymphoma and provide a systematic review of existing literatures to improve our understanding of this rare liver disease. METHODS: We followed-up five cases of hepatic pseudolymphoma in West China Hospital from January 2002 to January 2022. We also summarized the cases of hepatic pseudolymphoma from January 1981 to December 2021 through the PubMed database and comprehensively analyzed the characteristics of the cases. RESULTS: The pathologic features of the five cases were characterized by benign lymphoid tissue hyperplasia, lymphoid follicle formation, and a polarized germinal center. Immunohistochemistry, in situ hybridization, and gene rearrangement revealed non-malignant lymphoma. Besides, a total of 116 cases have been reported in the PubMed database from 1981 to 2021. The incidence of hepatic pseudolymphoma is higher in middle-aged and elderly women and has been reported more frequently in Asia. All cases were pathologically diagnosed, among which 85.95% of the patients were treated by surgery. CONCLUSIONS: Hepatic pseudolymphoma is an extremely rare benign disease, mainly in middle-aged and elderly women. Without distinctive clinical and imaging characteristics, pathological diagnosis is the highly reliable method at present. Thus, in the absence of risk factors for a primary liver tumor or metastatic tumor in middle-aged and elderly women, the possibility of pseudolymphoma should be considered to avoid extensive treatments.
Subject(s)
Liver Diseases , Liver Neoplasms , Pseudolymphoma , Middle Aged , Aged , Humans , Female , Pseudolymphoma/diagnosis , Pseudolymphoma/pathology , Liver Diseases/surgery , Liver Neoplasms/pathology , Immunohistochemistry , Diagnosis, DifferentialABSTRACT
Drug-induced cutaneous pseudolymphoma (CPL) is a common form of pseudolymphoma and there are numerous drugs associated with it. In this study, we performed a systematic review of the literature by searching PubMed/Medline and Embase databases to determine the most common drugs responsible for CPL and to define the demographic, clinical, histopathological and immunopathological characteristics of patients (updated on 30 December 2020). From 883 initially found articles, 56 studies (89 reported cases) were included. The mean age of patients was 54.4 ± 17.7 (ranging 8-86) years, and 46 (51.7%) were men. The median time interval between drug intake and CPL occurrence was 120 days (range 1-7300 days). The shortest median time interval between taking the drug and the onset of the disease was observed among patients taking antidepressants (60 days) (range 7-540) and the longest median time interval was observed in individuals using immunomodulators (300 days) (range 3-7300). The most-reported drug categories causing CPL were anti-hypertensives (17.9%), anticonvulsants (14.6%), monoclonal antibodies (13.4%) and antidepressants (11.2%). Moreover, the most common drugs were phenytoin (6.7%), amlodipine (5.6%), fluoxetine (5.6%) and carbamazepine (4.4%). Histopathological evaluation of 76 cases revealed 62 (81.5%) reports of T-cell infiltrations. Furthermore, positive reports of CD4 (94.0%), CD8 (93.0%) and CD30 (87.5%) were noted. The lowest prevalence of CD30-positive reports was observed among monoclonal antibodies. In conclusion, anti-hypertensives, anti-convulsants, monoclonal antibodies and anti-depressants are the most common drugs responsible for CPL. It mostly presents in middle-aged patients with almost no gender difference as pruritic papules, nodules and plaques.
Subject(s)
Pseudolymphoma , Male , Middle Aged , Humans , Child , Adolescent , Young Adult , Adult , Aged , Aged, 80 and over , Female , Pseudolymphoma/chemically induced , Pseudolymphoma/diagnosis , Antihypertensive Agents/adverse effects , Anticonvulsants/adverse effects , Carbamazepine/adverse effects , Antibodies, Monoclonal/adverse effectsSubject(s)
Dermatitis, Allergic Contact , Pseudolymphoma , Skin Diseases , Skin Neoplasms , Humans , Pseudolymphoma/chemically induced , Pseudolymphoma/diagnosis , Acrylates/adverse effects , Dermatitis, Allergic Contact/complications , Skin Neoplasms/diagnosis , T-Lymphocytes , Skin Diseases/chemically inducedABSTRACT
Cutaneous pseudolymphomas (CPL) is a group of benign, reactive, and polyclonal lymphoproliferative dermatoses that simulate cutaneous lymphomas (CL) clinically and histologically. Based on the predominating component of lymphocytic infiltrate, CPL can be divided into cutaneous B-cell pseudolymphomas (CBPL), cutaneous T-cell pseudolymphomas (CTPL), mixed (T-/B-cell) pseudolymphomas, CD30-positive pseudolymphomas, and non-classifiable pseudolymphomas. Most patients with localized nodular CBPL present with a solitary nodule. However, few patients develop multiple skin lesions, rarely in generalized forms. Here we describe a rare case of multiple nodular CBPL on both sides of the patient's neck, which was treated successfully with intramuscular injection of compound betamethasone, oral methotrexate, and hydroxychloroquine for 4 months. No recurrence was observed in the patient at the one-year follow-up. This combined treatment may be a promising treatment choice for multiple nodular CBPL.
Subject(s)
Pseudolymphoma , Skin Diseases , Skin Neoplasms , Humans , Pseudolymphoma/diagnosis , Pseudolymphoma/drug therapy , Pseudolymphoma/pathology , Methotrexate/therapeutic use , Hydroxychloroquine/therapeutic use , Glucocorticoids/therapeutic use , Diagnosis, Differential , Skin Diseases/diagnosis , Skin Diseases/drug therapy , Skin Diseases/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/drug therapy , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: T-cell-rich angiomatoid polypoid pseudolymphoma (TRAPP) and inflammatory lobular hemangioma (ILH) encompass a spectrum of cutaneous vascular lesions in which a prominent lymphoplasmacytic component may impart a pattern highly reminiscent of low-grade cutaneous lymphoma (pseudolymphoma). Epithelioid hemangioma, including its most common variant angiolymphoid hyperplasia with eosinophilia (ALHE), is a distinct entity associated with FOS and/or FOSB expression detected by immunohistochemistry (IHC). These entities can show significant morphological overlap. METHODS: We performed IHC for FOSB, FOS, and lymphoid markers in a series of TRAPP/ILH and ALHE. RESULTS: We identified 13 cases of ILH/TRAPP, which showed a predominance in CD8+ T-cells (CD8>CD4: 11/13) while FOSB and FOS were expressed in 36% (4/11) and 27% (3/11) of cases, respectively. ALHE (n = 9) showed a predominance in CD4+ T-cell (67%) with FOSB and FOS co-expression in 78% (seven of nine) of the cases. CONCLUSION: We showed, based on FOS and/or FOSB immunohistochemical expression, that there is a possible link between ILH/TRAPP and epithelioid hemangioma/ALHE. The use of FOS and FOSB IHC in the routine diagnostic setting of cutaneous vascular lesions will help to redefine cases of ILH/TRAPP as a subset of these may represent inflammatory variants of epithelioid hemangioma.