Cutaneous marginal zone B‐cell lymphoma in the setting of fluoxetine therapy: a hypothesis regarding pathogenesis based on in vitro suppression of T‐cell‐proliferative response

Abstract

Fluoxetine may be associated with pseudolymphomata and marginal zone lymphoma. The inhibitory effects on T-lymphocyte function and more specifically T-suppressor function may lead to excessive antigen-driven B-cell proliferation.

Mimics of Cutaneous Lymphoma

“…This suppressive effect on T-cell function may lead to overresponsiveness of B cells to unknown antigens, which in turn may foster antigenically responding B-cell clones, possibly a critical event in B-cell lymphomagenesis. 33,34 Interestingly, 2 submitted cases dramatically illustrated a "lymphomatoid reaction" and "benign lymphoid hyperplasia," most likely secondary to ongoing sertraline (Zoloft) therapy (Image 2). Ultimately, the diagnosis of drug-associated pseudolymphoma is established based on the resolution of skin lesions with cessation of drug therapy, which may take weeks or even months.…”

“…Ultimately, the diagnosis of drug-associated pseudolymphoma is established based on the resolution of skin lesions with cessation of drug therapy, which may take weeks or even months. 27,31,33 Finally, an inflammatory disorder may occur with reexposure following prior sensitization to a particular allergen. Rarely, contact dermatitis may simulate MF histologically (so-called lymphomatoid contact dermatitis).…”

Pigmented Purpuric Dermatosis

“…We have shown in an earlier study that antidepressants are associated with the development of clonally restricted T-cell infiltrate and with a significant suppression in T-cell function. 22,23 It is possible that there is a selective down-regulation of the regulatory Tcell population, the sequelae of which would be an attenuated response to control the emergence of various antigen responding T-cell clones.…”

Cutaneous Hematopathology

“…Over a period of 4 years, his skin lesions evolved from being histopathologically benign (mild-moderate, superfi cial and deep, predominantly perivascular lymphohistiocytic infi ltrate with admixed plasma cells) and immunologically polyclonal pseudolymphoma to histopathologically malignant (dense, superfi cial and mid, nodular to diffuse infi ltrate composed of large atypical lymphoid cells with admixed eosinophils and small lymphocytes) and immunologically monoclonal large B-cell lymphoma indicating that follow-up is essential (Sangueza et al 1992 ). In all biopsies, there were common clonal bands of varied intensity relative to the germline bands (refl ecting a variability in the proportion of clonal cells) -fi nding favoring the concept of evolution from an abnormal immune state with multiple B-lymphocyte clones in the pseudolymphoma to a dominant and relatively uncontrollable proliferation of one clonal population in overt lymphoma (Breza et al 2006 ).…”