CD30-Positive T-Cell Lymphoproliferative Disorder of the Oral Mucosa—An Indolent Lesion: Report of 4 Cases

Abstract

Four cases of CD30-positive T-cell lymphoproliferative disorder (CD30+ LPD) of the oral mucosa are described. This article aims to draw attention to this entity and to emphasize its usual benign clinical behavior despite its resemblance to T-cell lymphoma. All the patients were adults. Three of the lesions were on the dorsal surface of the tongue and 1 affected the buccal mucosa. All biopsies showed a dense lymphoid infiltrate composed of CD30+ atypical T cells with a polymorphous infiltrate in the background, which included eosinophils. In 1 case, monoclonal T-cell expansion was detected by molecular techniques. Three cases tested for Epstein-Barr virus were all negative. It is concluded that primary CD30+ T-cell LPD of the oral mucosa can be regarded as the oral counterpart of cutaneous CD30+ LPD such as lymphomatoid papulosis or anaplastic large cell lymphoma. Recognition of the condition is important to avoid overtreatment.

Mucosal CD30-positive T-cell lymphoproliferations of the head and neck show a clinicopathologic spectrum similar to cutaneous CD30-positive T-cell lymphoproliferative disorders

“…Indolent CD30-positive T-cell lymphoproliferations have been reported previously in the oral cavity, especially the tongue, and variably designated traumatic ulcerative granuloma with stromal eosinophila, traumatic eosinophilic granuloma, eosinophilic ulcer of the oral mucosa and Riga (or Riga-Fede) disease. [11][12][13][14][15][16][17][18][19][20] These terms connote a reactive process. 17,19 Reports of seemingly similar processes have been described as lymphomatoid papulosis (in the absence of co-existing cutaneous disease) 21 or as T-cell lymphoma.…”

“…14 Some investigators have used the term CD30-positive T-cell lymphoproliferative disorder and have suggested this spectrum of lesions represents the oral counterpart of cutaneous CD30-positive T-cell lymphoproliferative disorder. 15,16,18 However, strict criteria for these diagnostic terms have not been defined, and only more recent studies have included examination for expression of CD30. Here, we have used the term CD30-positive T-cell lymphoproliferations as it is not certain in all cases whether these are reactive or neoplastic processes.…”

“…38 Designating primary mucosal CD30-positive T-cell lymphoproliferations as ALK-negative anaplastic large cell lymphomas (or other peripheral T-cell lymphoma subtype) might lead to overtreatment as suggested previously. 16,18 As shown in Table 2, some patients in our series with disease limited to the mucosa received systemic chemotherapy. It is not possible from our retrospective data to determine whether this therapy was beneficial, and consequently we cannot make treatment recommendations for these localized cases.…”

Lymphomas of the Head and Neck

“…It is characterized by a polymorphic infiltrate of T lymphocytes, B lymphocytes, histiocytes, eosinophils, and large atypical cells that often prove to be CD30+ T cells. 156,157 The large cells usually are mononuclear but may be binucleated, occasionally resembling Reed-Sternberg cells. Occasionally, molecular studies have documented a clonal T-cell population.…”

Traumatic ulcerative granuloma with stromal eosinophilia of the palate showing an angiocentric/angiodestructive growth pattern

“…Eosinophils and cytotoxic large atypical CD30+ cells may be observed, with some authors considering that a subset of TUGSE could be better classified as the oral counterpart of the primary cutaneous CD30+ lymphoproliferative disorders (LPDs). [1–3] TUGSE with extensive vascular destruction mimicking malignant lymphoma is unusual. This angiocentric/angiodestructive growth pattern is characteristic of natural killer (NK)/T-cell lymphoma, nasal type, being rare in other LPDs.…”