Pseudoepitheliomatous hyperplasia in cutaneous T-cell lymphoma. A clinical, histopathological and immunohistochemical study with particular interest in epithelial growth factor expression

Abstract

Pseudoepitheliomatous hyperplasia has occasionally been reported in cutaneous T-cell lymphoma (CTCL). This association raises the question of the relationship between epidermal hyperplasia and the lymphomatous infiltrate. Because epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) have been demonstrated to be involved in epidermal proliferation through binding to EGF receptor (EGFr), we tested the hypothesis that these cytokines could be secreted by lymphomatous cells, and induce the overlying pseudoepitheliomatous hyperplasia. The purposes of this study were: (i) to describe the clinical and immunohistological features of pseudoepitheliomatous hyperplasia; (ii) to determine its frequency in a large series of CTCLs; and (iii) to evaluate the expression of EGF, TGF-alpha and EGFr in CTCL with or without pseudoepitheliomatous hyperplasia. Eleven cases of CTCL with pseudoepitheliomatous hyperplasia were collected from a series of 353 cases of cutaneous lymphoma registered from 1990 to 1996. They consisted of eight of 28 (28.5%) CD30+ large T-cell lymphomas and three of 148 (2%) cases of mycosis fungoides. Epidermal expression of EGF, EGFr and TGF-alpha was stronger in CTCL than in control normal human skin. Lymphomatous T cells expressed EGF and TGF-alpha whereas no expression of these cytokines could be detected in cutaneous and nodal B-cell lymphomas, nor in a normal lymph node. In addition, epidermal expression of EGFr was stronger in CTCL with pseudoepitheliomatous hyperplasia than in control cases of CTCL without pseudoepitheliomatous hyperplasia, suggesting that these cytokines, in association with other factors, are probably involved in the epidermal hyperplasia observed in some cases of CTCL.

Pseudoepitheliomatous Hyperplasia In Mycosis Fungoides

“…The authors concluded that these cytokines were probably involved in PEH observed in some cases of cutaneous T cell lymphoma. [3] On the other hand, Scarisbrick et al reported that there was no aberrant expression of EGF, EGFr and TGF-in either epidermis or atypical lymphocytes compared with adjacent normal epidermis. [6] In conclusion, our patient presented with a few large, vegetative nodules that clinically appeared as the tumor stage of MF along with typical plaque lesions of MF.…”

“…[5] PEH, has occasionally been reported in the literature as a manifestation of cutaneous lymphomas. It has been associated especially with CD30+ anaplastic large cell lymphoma in the majority of cases [3,4,6] and rarely with lymphomatoid papulosis type A [6] and MF. [3,4] The first comprehensive study describing the clinical and histopathological features of PEH in cutaneous T-cell lymphomas was reported by Courville et al in 1999, although this particular association had rarely been reported previously.…”

“…It has been associated especially with CD30+ anaplastic large cell lymphoma in the majority of cases [3,4,6] and rarely with lymphomatoid papulosis type A [6] and MF. [3,4] The first comprehensive study describing the clinical and histopathological features of PEH in cutaneous T-cell lymphomas was reported by Courville et al in 1999, although this particular association had rarely been reported previously. [7,8] The authors studied 11 cases with PEH which were collected from a series of 353 cutaneous lymphomas registered between 1990 and 1996 by the French Study Group of Cutaneous Lymphomas in their study.…”

“…[4] These patients present with exophytic scaling plaques, nodules [4] or seborrhoeic keratosis-like lesions. [3] These unusual clinical and histopathological types can cause problems either during the diagnosis or in staging of patients with MF.…”

“…[1] Moreover, the histopathological diagnosis of MF can be difficult, especially in the early patch stage but also in advanced stages. [2] There are also some unusual histological types of MF such as MF with pseudoepitheliomatous hyperplasia (PEH) [3] and pseudotumorous folliculotropic MF. [4] These patients present with exophytic scaling plaques, nodules [4] or seborrhoeic keratosis-like lesions.…”