A Primary Cutaneous CD30-Positive T-Cell Lymphoproliferative Disorder Arising in a Patient With Multiple Myeloma and Cutaneous Amyloidosis

Abstract

CD30-positive cutaneous lymphoproliferative disorders, a group of T-cell neoplasms, including lymphomatoid papulosis (LyP) and cutaneous anaplastic large cell lymphoma, require careful clinicopathologic correlation for diagnosis. An association between LyP and the development of a second hematolymphoid malignancy has been established in the literature. LyP has also been reported with systemic amyloidosis, but no such reports have documented coexisting cutaneous amyloid deposition with LyP to our knowledge. A 66-year-old woman with cutaneous amyloidosis, secondary to multiple myeloma, in remission, presented with erythematous and dark-brown papules involving the right arm, scalp, and torso. Punch biopsy of the arm showed a dermal infiltrate of intermediate-sized lymphocytes, some of which displayed a plasmacytoid morphology and prominent nodular subepidermal amyloid deposition. Punch biopsy of the scalp similarly showed a nonepidermotropic dense dermal infiltrate of intermediate-sized plasmacytoid lymphocytes and multifocal amyloid deposition. Both infiltrates were immunophenotypically CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoproliferative processes. Subsequent studies showed no systemic involvement, and clinical correlation suggested a final diagnosis of LyP. We present this case of LyP, which histologically mimics a B-cell proliferation with a plasmacytoid morphology arising in association with cutaneous amyloidosis to highlight the importance of clinicopathologic correlation, a thorough battery of immunohistochemical studies, and consideration for a second hematologic malignancy arising in the setting of LyP.

Aggressive Disease Course of Multiple Myeloma with Concomitant ALK-Negative Anaplastic Large Cell Lymphoma: A Case Report with an Unusual Presentation

“…Regarding concomitant diagnosis of T-cell lymphoma and MM, in the few other cases described in the literature [5][6][7], the diagnosis of a T-cell neoplasm occurred later than the diagnosis of MM, leading to surmise a pathogenic role for acquired cellular immunity impairment, on turn caused by PC disorders or previous therapies. In our patient the relationship between the two neoplasms was unclear, and the chronologic sequence of onset could not be proven.…”

“…Few cases of concomitant diagnosis of multiple myeloma and T-cell neoplasms are described, mainly regarding CD30+ cutaneous anaplastic large cell lymphoma. Often the plasma cell dyscrasia precedes the diagnosis of the T-cell neoplasm [5][6][7]. Some authors have hypothesized a causal relationship between the two diseases, but the potential pathogenic mechanism has not been fully understood [7].…”