Hydantoin-induced cutaneous pseudolymphoma with clinical, pathologic, and immunologic aspects of Sezary syndrome

D'Incan, M.

doi:10.1001/archderm.128.10.1371

Cited by 12 publications

(9 citation statements)

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“…4,5 More rarely, the lesions may be extensive, mimicking erythrodermic MF or Se Âzary syndrome. 6,7 Histological features are polymorphic even if MF pattern is frequently described, with a dermal bandlike infiltrate of atypical T lymphocytes and moderate epidermotropism. Some histological features, such as discrete epidermotropism and the presence of associated epidermal alterations (keratinocyte necrosis, spongiosis), may be helpful in suspecting PL rather than lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…Patchy and discreetly infiltrated single or localized lesions mimicking mycosis fungoides (MF) are mostly reported 4,5 . More rarely, the lesions may be extensive, mimicking erythrodermic MF or Sézary syndrome 6,7 . Histological features are polymorphic even if MF pattern is frequently described, with a dermal band‐like infiltrate of atypical T lymphocytes and moderate epidermotropism.…”

Section: Discussionmentioning

confidence: 99%

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Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine

et al. 2001

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We report a patient with a sodium valproate-induced cutaneous pseudolymphoma, presenting with an erythematous papule, histologically mimicking a non-epidermotropic T-cell lymphoma. Polymerase chain reaction study of the skin biopsy revealed monoclonal rearrangement of the T-cell receptor gamma gene. Withdrawal of sodium valproate was followed by regression of the lesion, but 5 months after substitution by carbamazepine, two further papules appeared, with similar histological features and a T-cell clone identical to the initial one. Carbamazepine was stopped and the lesions disappeared without relapse over a 4-year follow-up. Sodium valproate is very rarely responsible for a hypersensitivity syndrome, and our case is the first report of sodium valproate-induced cutaneous pseudolymphoma. The recurrence with carbamazepine may be due to a common effect on T-cell lymphocyte function. The return of the same monoclonal population shows that the recurrence of monoclonal T cells may be observed in benign conditions and is not an exclusive hallmark of cutaneous lymphoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine

et al. 2001

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“…In patients with benign inflammatory disease and even healthy individuals, a small number of Sézary cells are commonly observed, and therefore, the Sézary cell count has no diagnostic relevance unless it is high (≥20% of the lymphocyte population or absolute count ≥ 1.0 K/µL). Even then, Sézary cell counts can occasionally exceed the 20% or 1.0 K/µL cut‐points in certain benign conditions such as severe photosensitivity or drug reactions, 61–65 but usually, these can be distinguished on clinical grounds.…”

Section: Blood Studiesmentioning

confidence: 99%

“…In the author's experience, the main non‐neoplastic condition that can suggest the histologic diagnosis of CTCL in the clinical setting of diffuse eruptions or erythroderma are drug‐induced eruptions, especially anticonvulsants (hydantoin, phenobarbital, carbamazepine, and sodium valproate), angiotensin‐converting enzyme inhibitors, β‐blockers, antidepressants, phenothiazines, and H1/2 histamine‐receptor antagonists. It should be noted that drug‐induced pseudolymphomas (also called lymphomatoid vascular reactions) may have a detectable T‐cell clone in the skin 39,92–95 or have increased number of Sézary cells in the blood, even to the degree that suggests SS 63,64 , 96 . Indeed, Magro proposed that drugs that can perturb lymphoid function in vitro are capable of inducing in vivo a clonal expansion of memory T cells that often are deficient in CD7 and CD62L and thus closely mimic CTCL 39 .…”

Section: Pitfalls and Differential Diagnosismentioning

confidence: 99%

On the diagnosis of erythrodermic cutaneous T‐cell lymphoma

Vonderheid

2006

J Cutan Pathol

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Erythrodermic cutaneous T-cell lymphoma (E-CTCL) is the cause of less than 5% of all cases of generalized erythroderma. A methodical evaluation of skin, blood, and lymph node samples using standard histology, immunohistochemistry (IHC), flow cytometry (FC), and molecular analysis for evidence of a dominant T-cell clone has been recommended in a recently published diagnostic algorithm. In this commentary, the author discusses available information regarding the role of these diagnostic methods for the diagnosis of E-CTCL with emphasis on personal observations regarding skin IHC and polymerase chain reaction (PCR)-based molecular studies as adjunct diagnostic studies on a series of 55 patients with erythrodermic mycosis fungoides and 50 patients with Sézary syndrome compared to 50 patients with extensive benign inflammatory skin disease. The conclusions are (1) IHC of the skin does not reliably differentiate E-CTCL from benign simulants, (2) presence of phenotypically abnormal T cells in the blood or expanded subsets of CD4+CD7- or CD4+CD26- cells by FC is particularly helpful as a diagnostic study, (3) the presence of an identical T-cell clone in the skin and blood also is a specific diagnostic criterion for E-CTCL, but exceptions may occur, and (4) the PCRgamma-denaturing gradient gel electrophoresis technique appears to be more reliable than PCRgamma-single-stranded conformational polymorphism for diagnostic purposes.

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“…Entretanto, valores de CS ≥ 20% são encontrados em pacientes com eritrodermias reativas, particularmente no reticulóide actínico (Chu et al, 1986) e nos pseudolinfomas induzidos por drogas (Rosenthal et al, 1982;D'Incan et al, 1992 (Economidou et al, 1985;Lima et al, 2003). A expressão de CD7, que ocorre normalmente em cerca de 90% das células T CD4 + é deficiente nas células T malignas circulantes (CD4 + CD7 -) em aproximadamente 60 -70% dos casos de SS (Jakob et al, 1996;Harmon et al, 1996;Bernengo et al, 1998;Laetsch et al, 2000).…”

Section: Presença De Células De Sézary No Sangue Periféricounclassified

"Estudo do perfil morfológico e imunofenotípico dos linfócitos do sangue periférico de pacientes portadores de micose fungóide nas fases precoce e avançada"

Oliveira¹

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Dedico este trabalho a:Deus, que me permitiu fazer parte de uma família tão maravilhosa e percorrer o caminho do aprendizado e das conquistas para a realização deste trabalho.Meus pais Manoel e Luzia que com muito amor me ensinaram a conhecê-Lo e amá-Lo em todas as coisas, e me orientaram para que eu pudesse seguir o caminho para a busca permanente da verdade.Minha irmã Gisele que me mostrou o quanto pode haver de amor nas diferenças e possibilitou conviver com seu filho tão querido, Pedro José.Alexandre, meu grande companheiro, que com muito amor e abnegação adiou projetos e momentos de sua vida, passou por situações únicas com nosso bebê para a realização deste trabalho.Meu querido filho João Guilherme que, com a pureza de seu amor, a cada dia me mostra, na forma mais perfeita, a existência de Deus. AGRADECIMENTOS

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Hydantoin-induced cutaneous pseudolymphoma with clinical, pathologic, and immunologic aspects of Sezary syndrome

Cited by 12 publications

References 0 publications

Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine

Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine

On the diagnosis of erythrodermic cutaneous T‐cell lymphoma

"Estudo do perfil morfológico e imunofenotípico dos linfócitos do sangue periférico de pacientes portadores de micose fungóide nas fases precoce e avançada"

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