Specific Skin Infiltration as First Sign of Localized Stage Hodgkin's Lymphoma Involving an Epitrochlear Node

Abstract

Cutaneous manifestation as the first sign of Hodgkin lymphoma (HL) is very rare and diagnostically challenging; especially, because the clinical presentation of specific skin involvement by HL is polymorphous. We present a 44-year-old man with erythematous indurate papules and plaques in the right forearm and arm where skin biopsy showed an HL. He also has an enlarged epitrochlear node, and later histopathologic study confirmed the diagnosis of HL subtype-mixed cellularity. Immunohisto-chemical stains in both biopsies showed that the atypical cells were positive for CD30 and CD15, and negative for CD20 and CD3. PAX5 stained the nuclei of the atypical large lymphoid cells weakly and Oct-2 staining was negative in the atypical cells. EBER and LMP1 protein were negative in both biopsies. Epitrochlear involvement in HL, like in our case, is a rare event (<1%). We reviewed data about prognosis, clinical appearance, and treatment of all the cases of HL specific skin involvement published after Sioutos et al, emphasizing the cases where HL specific skin involvement was the first sign of the disease as in our patient. Abstract: Cutaneous manifestation as the first sign of Hodgkin lymphoma (HL) is very rare and diagnostically challenging; especially, because the clinical presentation of specific skin involvement by HL is polymorphous. We present a 44-year-old man with erythematous indurate papules and plaques in the right forearm and arm where skin biopsy showed an HL. He also has an enlarged epitrochlear node, and later histopathologic study confirmed the diagnosis of HL subtype-mixed cellularity. Immunohistochemical stains in both biopsies showed that the atypical cells were positive for CD30 and CD15, and negative for CD20 and CD3. PAX5 stained the nuclei of the atypical large lymphoid cells weakly and Oct-2 staining was negative in the atypical cells. EBER and LMP1 protein were negative in both biopsies. Epitrochlear involvement in HL, like in our case, is a rare event (,1%). We reviewed data about prognosis , clinical appearance, and treatment of all the cases of HL specific skin involvement published after Sioutos et al, emphasizing the cases where HL specific skin involvement was the first sign of the disease as in our patient. (Am J Dermatopathol 2014;0:1-4)

Cutaneous localization of angioimmunoblastic T‐cell lymphoma may masquerade as B‐cell lymphoma or classical Hodgkin lymphoma: A histologic diagnostic pitfall

“…9,22,24,[36][37][38] Whenever IGH gene rearrangement analysis was performed, we identified an abnormal and clonal B-cell population in association. 24,36 In this report, all three cases showed a clonal B-cell population in Although skin occurrence of cHL is rare and poorly described in the literature, [43][44][45][46][47][48] it has been described in advance stages of the disease and associated with adverse prognosis. 43 Phenotypically, tumor cells harbor the classical morphology and phenotype, strong expression of CD30 and CD15, weak PAX5 expression and lack other B-cell markers.…”

“…Although skin occurrence of cHL is rare and poorly described in the literature, it has been described in advance stages of the disease and associated with adverse prognosis . cHL cutaneous involvement may occur as a unique cutaneous ulcer, cutaneous nodules or erythematous indurate papules and plaques …”

“…,45 cHL cutaneous involvement may occur as a unique cutaneous ulcer, 46,47 cutaneous nodules 48 or erythematous indurate papules and plaques 44. …”

Clinical significance and epidemiological evolution of epitrochlear lymphadenopathy in pre- and post-highly active antiretroviral therapy era: A systematic review of the literature

“…We identified 144 articles, of which 79 (including 507 subjects) were found to be eligible for inclusion. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 ] Infections ( n = 356, 70.2%) and neoplasms ( n = 116, 22.9%) were the most common reported cau...…”

Infiltration of abdominal striae distensae by Hodgkin's lymphoma

“…Cutaneous manifestation as the first sign of HL poses a diagnostic challenge in that the clinical presentation of specific skin involvement by HL is polymorphous and includes unusual features . It is reported in 0.5–3.4% of cases of HL, generally in patients with human immunodeficiency virus; it tends to appear late in the course of the disease and is clinically aggressive, posing a major challenge to the immune system .…”