A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation

Abstract

Context.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The “tough” cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). Objective.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. Data Sources.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. Conclusions.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and “reactive” infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.

An accurate diagnosis of dermal CD8 + lymphoproliferative disorders requires clinicopathological and immunophenotypic correlation

“…Cutaneous lymphomas are diagnostically challenging from a clinical and pathological perspective. Most cases are CD4 + , and the CD8 + lymphoproliferative disorders (LPDs) in the skin are largely accounted for by mycosis fungoides (typically paediatric and hypopigmented lesions), lymphomatoid papulosis (types D and E) and cutaneous anaplastic large cell lymphoma 1,2 . In 2007, Petrella et al 3 .…”

Distribution and clinical features of lymphomas involving skin in Taiwan

“…Adult T‐cell leukemia/lymphoma (ATLL) is associated with human T‐lymphotropic virus 1 (HTLV‐1) infection and most prevalent in Japan 10 . The clinical presentations of cutaneous lymphomas also represent a broad spectrum, 14 and a comprehensive evaluation and a detailed clinicopathological correlation are critical in the diagnosis of cutaneous lymphomas 1 …”

“…10,11,13 Adult T-cell leukemia/lymphoma (ATLL) is associated with human T-lymphotropic virus 1 (HTLV-1) infection and most prevalent in Japan. 10 The clinical presentations of cutaneous lymphomas also represent a broad spectrum, 14 and a comprehensive evaluation and a detailed clinicopathological correlation are critical in the diagnosis of cutaneous lymphomas. 1 The diagnosis of primary cutaneous lymphomas is defined as no evidence of extracutaneous involvement at the time of diagnosis with compatible morphological and immunohistochemical features.…”