Cutaneous Lymphomas, An Issue of Surgical Pathology Clinics (eBook)

Antonio Subtil (Autor)

eBook Download: PDF | EPUB

2014 | 1. Auflage
169 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-27785-3 (ISBN)

Infos

Knowledge of cutaneous lymphomas has been growing significantly as a result of important discoveries in immunology, molecular biology, and immunohistochemistry. Improved clinical pathologic correlation and follow-up data, as well as the synergistic collaboration among different lymphoma registries and specialists from several academic medical centers have greatly contributed to the understanding of the difficult field of cutaneous lymphoproliferative disorders. While these advances have increased understanding of skin lymphomas, they have also produced an extensive and sometimes confusing litany of articles, studies, and classification schemes. This issue on Cutaneous Lymphomas in Surgical Pathology Clinics provides an organized and updated review of this challenging topic by leading experts. It bridges critical knowledge gaps in the diagnosis of cutaneous lymphomas. Sezary Syndrome, Mycosis Fungoides and variants are presented along with B-cell, CD30, lymphoproliferative disorders among others. In addition to multiple clinical and microscopic images, tables and algorithms are presented to aid in diagnosis and staging. Beyond its usefulness to general pathologists, dermatopathologists, and hematopathologists, this information is intended to be helpful for dermatologists, hematologists/oncologists, fellows, and residents.

Inhalt

Front Cover 1
Cutaneous Lymphomas 
2 
copyright 
3 
Contributors 4
Contents 6
Surgical Pathology Clinics 
8 
Preface 
10 
A General Approach to the Diagnosis of Cutaneous Lymphomas and Pseudolymphomas 12
Abstract 12
Key points 12
Overview 12
References 19
Mycosis Fungoides 20
Abstract 20
Key points 20
Overview 20
Clinical features 20
Diagnosis: microscopic features 24
Diagnosis: ancillary studies 30
Differential diagnosis 34
Prognosis 42
References 43
Mycosis Fungoides Variants 46
Abstract 46
Key points 46
Overview 46
Folliculotropic mycosis fungoides 47
Overview 47
Clinical Features 47
Diagnosis: Microscopic Features 47
Diagnosis: Ancillary Studies 51
Differential Diagnosis 51
Prognosis 51
Pagetoid reticulosis (Woringer-Kolopp disease) 52
Overview 52
Clinical Features 52
Diagnosis: Microscopic Features 53
Diagnosis: Ancillary Studies 53
Differential Diagnosis 53
Prognosis 55
Granulomatous slack skin syndrome 55
Overview 55
Clinical Features 56
Diagnosis: Microscopic Features 56
Diagnosis: Ancillary Studies 56
Differential Diagnosis 56
Prognosis 58
Hypopigmented mycosis fungoides 58
Overview 58
Clinical Features 59
Diagnosis: Microscopic Features 59
Diagnosis: Ancillary Studies 59
Differential Diagnosis 60
Prognosis 60
Other rare variants of MF 60
References 64
Sézary Syndrome 68
Abstract 68
Key points 68
Overview 68
Clinical features 69
Diagnosis: microscopic features 70
Diagnosis: ancillary studies 73
Differential diagnosis 76
Prognosis 77
References 78
Cutaneous CD30-Positive Lymphoproliferative Disorders 80
Abstract 80
Overview 80
LyP 81
Overview 81
Diagnosis: Clinical Features 81
Diagnosis: Microscopic Features 82
Diagnosis: Ancillary Studies 85
Differential Diagnosis 89
Prognosis 91
Primary cutaneous anaplastic large-cell lymphoma 93
Overview 93
Clinical Features 94
Diagnosis: Microscopic Features 94
Diagnosis: Ancillary Studies 97
Differential Diagnosis 97
Prognosis 98
Borderline lesions 99
CD30 as prognostic marker and expression in other lymphomas 100
CD30 as therapeutic marker 100
References 101
CD30-Negative Cutaneous T-Cell Lymphomas Other than Mycosis Fungoides 106
Abstract 106
Key points 106
Overview 106
Subcutaneous panniculitis–like T-cell lymphoma 107
Overview 107
Clinical Features 107
Diagnosis: Microscopic Features 108
Diagnosis: Ancillary Studies 108
Differential Diagnosis 110
Prognosis 110
Extranodal NK/T-cell lymphoma, nasal type 110
Overview 110
Clinical Features 110
Diagnosis: Microscopic Features 110
Diagnosis: Ancillary Studies 110
Differential Diagnosis 111
Prognosis 111
Hydroa vacciniforme–like lymphoma 111
Overview 111
Clinical Features 111
Diagnosis: Microscopic Features 113
Diagnosis: Ancillary Studies 114
Differential Diagnosis 114
Prognosis 114
Primary cutaneous gamma-delta T-cell lymphoma 114
Overview 114
Clinical Features 114
Diagnosis: Microscopic Features 115
Diagnosis: Ancillary Studies 115
Differential Diagnosis 115
Prognosis 115
Primary cutaneous aggressive epidermotropic CD8-positive cytotoxic T-cell lymphoma (provisional entity) 116
Overview 116
Clinical Features 116
Diagnosis: Microscopic Features 116
Diagnosis: Ancillary Studies 116
Differential Diagnosis 116
Prognosis 118
Primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoma (provisional entity) 118
Overview 118
Clinical Features 118
Diagnosis: Microscopic Features 118
Diagnosis: Ancillary Studies 121
Differential Diagnosis 121
Prognosis 123
Primary cutaneous peripheral T-cell lymphoma, not otherwise specified 125
Overview 125
Clinical Features 125
Diagnosis: Microscopic Features 125
Diagnosis: Ancillary Studies 125
Differential Diagnosis 126
Prognosis 127
References 127
Primary Cutaneous B-Cell Lymphomas 130
Abstract 130
Overview 130
PCMZL 131
Overview/Definition 131
Clinical Features 131
Diagnosis: Microscopic Features 131
Diagnosis: Ancillary Studies 132
Differential Diagnosis 137
Prognosis 142
PCFCL 144
Overview/Definition 144
Clinical Features 144
Diagnosis: Microscopic Features 145
Diagnosis: Ancillary Studies 147
Differential Diagnosis 148
Prognosis 151
PCDLBCL-LT 151
Overview/Definition 151
Clinical Features 151
Diagnosis: Microscopic Features 151
Diagnosis: Ancillary Studies 151
Differential Diagnosis 153
Prognosis 157
Acknowledgments 158
References 158
Index 162

Textauszug

A General Approach to the Diagnosis of Cutaneous Lymphomas and Pseudolymphomas

Antonio Subtil, MD, [e-mail],     Yale Dermatopathology Laboratory, Yale School of Medicine, 15 York Street, LMP 5031, New Haven, CT 06520-8059, USA

Abstract

Both pathology and dermatology rely heavily on a visual approach to learning, generating differential diagnoses, and making diagnoses. Pattern recognition and the development of diagnostic frameworks are essential elements in this process. In addition to images, several algorithms and summaries are presented in this article to provide a practical approach to the diagnosis of cutaneous lymphoproliferative disorders. The critical importance of clinical pathologic correlation is also emphasized.

Keywords

Cutaneous lymphomas

Pseudolymphomas

Skin

T-cell

B-cell

Lymphoma

Diagnosis

Histopathology

Dermis

Epidermis

Key points

• Both pathology and dermatology rely heavily on a visual approach to learning, generating differential diagnoses (DDx), and making diagnoses.

• Pattern recognition and the development of diagnostic frameworks are essential elements in this process.

• In addition to images, several tables and algorithms are presented in this article to provide a practical approach to the diagnosis of cutaneous lymphoproliferative disorders.

• The critical importance of clinical pathologic correlation is also emphasized.

Overview

This issue on “Cutaneous Lymphomas” in Surgical Pathology Clinics provides an organized and updated review of this challenging topic by an international team of experts and bridges critical knowledge gaps in the diagnosis of cutaneous lymphomas. In addition to multiple clinical and microscopic images, several tables are presented to aid in diagnosis and staging. Both common and rare entities are reviewed—mycosis fungoides (MF), unique clinicopathologic variants of MF, cutaneous CD30-positive lymphoproliferative disorders, T-cell lymphomas without clinical features of MF or CD30 expression, and cutaneous B-cell lymphomas. For all entities, careful correlation of clinical and histopathologic findings is essential to arrive at the correct diagnosis (Fig. 1).

Fig. 1 Clinical pathologic correlation is essential to the diagnosis of skin lymphoma (HE, original magnification ×600).

Considering the heterogeneity and complexity of cutaneous lymphoproliferative disorders,1–3 this introductory article includes several tables and algorithms to provide a practical and logical approach to DDx based on different clinical findings (Fig. 2, Table 1) and histopathologic patterns (Boxes 1–6, Figs. 3–7). Within the differential list, each diagnostic possibility includes a link to a corresponding article for further information. In addition, it is important to recognize that several diseases (benign and malignant) may mimic cutaneous lymphomas. A comprehensive list of pseudolymphomas is provided in Box 7.

Box 1   Differential diagnosis of large cell lymphoid infiltrate (>25%–30% large cells)

• Large cell transformation of MF

See the article by Pincus elsewhere in this issue.

• LyP type C

The histologic features of LyP type C and pcALCL as well as sALCL are identical. To separate these entities, integration of clinical presentation and staging results as well as phenotypic and genetic findings are mandatory. See the article by Kempf elsewhere in this issue.

• Cutaneous anaplastic large cell lymphoma

See the article by Kempf elsewhere in this issue.

• Some cases of aggressive cytotoxic cutaneous lymphomas

See the article by Willemze elsewhere in this issue.

• Primary cutaneous peripheral T-cell lymphoma, unspecified

See the article by Willemze elsewhere in this issue.

• Primary cutaneous diffuse large B-cell lymphoma, leg type

See the article by Sundram elsewhere in this issue.

Abbreviations: LyP, lymphomatoid papulosis; pcALCL, primary cutaneous anaplastic large cell lymphoma; sALCL, systemic anaplastic large cell lymphoma.

Box 2   Differential diagnosis of perifollicular accentuation (lymphoid infiltrate around hair follicles)

• Folliculotropic MF

See the article by Martinez-Escala and colleagues elsewhere in this issue.

• Primary cutaneous marginal zone lymphoma

See the article by Sundram elsewhere in this issue.

• Some cases of lymphomatoid papulosis

See the article by Kempf elsewhere in this issue.

• Cutaneous pseudolymphoma: herpes folliculitis, pseudolymphomatous folliculitis, persistent arthropod bite reactions (see Box 7)

Box 3   Differential diagnosis of cutaneous lymphoid infiltrate with frequent eosinophils

• Folliculotropic MF

See the article by Martinez-Escala and colleagues elsewhere in this issue.

• Lymphomatoid papulosis type A

See the article by Kempf elsewhere in this issue.

• Cutaneous pseudolymphoma: lymphomatoid drug eruption, persistent arthropod bite reactions, scabies, exaggerated bitelike reactions in the setting of systemic hematologic disorders (see Box 7)

Box 4   Differential diagnosis of CD8 expression

• Lymphomatoid papulosis type D

See the article by Kempf elsewhere in this issue.

• Some cases of otherwise classical MF

See the article by Pincus elsewhere in this issue.

• Many cases of pagetoid reticulosis

See the article by Martinez-Escala and colleagues elsewhere in this issue.

• Some cases of cutaneous anaplastic large cell lymphoma

See the article by Kempf elsewhere in this issue.

• Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma

See the article by Willemze elsewhere in this issue.

• Subcutaneous panniculitis-like T-cell lymphoma

See the article by Willemze elsewhere in this issue.

• Many cases of cutaneous gamma/delta T-cell lymphoma

See the article by Willemze elsewhere in this issue.

• Indolent CD8+ lymphoid proliferation of the ear

See the article by Willemze elsewhere in this issue.

• Cutaneous pseudolymphoma: CD8+ infiltrates in the setting of advanced AIDS (see Box 7)

Box 5   Differential diagnosis of CD30 expression

• Lymphomatoid papulosis

See the article by Kempf elsewhere in this issue.

• Cutaneous anaplastic large cell lymphoma

See the article by Kempf elsewhere in this issue.

• Many (but not all) cases of large cell transformation of MF

See the article by Pincus elsewhere in this issue.

• Some cases of folliculotropic MF and pagetoid reticulosis

See the article by Martinez-Escala and colleagues elsewhere in this...

Produkt-Details

• Erscheint lt. Verlag: 9.8.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Pathologie
• ISBN-10: 0-323-27785-3 / 0323277853
• ISBN-13: 978-0-323-27785-3 / 9780323277853