1/4. Successful treatment of a patient with lymphomatoid papulosis by methotrexate.We report a case of lymphomatoid papulosis (LyP) that occurred in a 44-year-old Japanese male patient. Reddish papules with a small number of pustules and nodules were observed on the extremities, chest and upper back. Most lesions were also associated with central necrosis, ulceration and crusting, and regressed spontaneously within 4 to 6 weeks. Histopathological examination revealed wedge-shaped dense cellular infiltrate in the dermis, which was mixed with large atypical lymphoid cells, small lymphocytes, eosinophils and neutrophils. These large atypical cells expressed CD30 on their cell membrane and cytoplasm. Rearrangement of the T-cell receptor (TcR) beta-chain gene was detected in the skin lesion. Lymphadenopathy with histopathologic change similar to the skin lesions, but without TcR gene rearrangement, was found at the left inguinal area. Systemic administration of methotrexate (7.5-15.0 mg/week) was found to be dramatically effective in resolution of skin lesions and prevention of their recurrence.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/4. Eosinophilic histiocytosis. Histopathology and immunohistochemistry.We review the clinical features, histopathology, and immunohistochemistry in three cases of eosinophilic histiocytosis, comparing lymphomatoid papulosis and eosinophilic histiocytosis. Each of the patients presented with self-healing recurrent papules and ulcerative nodules that were associated with pruritus. disease duration was 5 months to 9 years. Histologically, the lesions demonstrated spongiosis and lymphocytic exocytosis, epidermal hyperplasia, papillary dermal edema, and a superficial and deep mixed perivascular inflammatory infiltrate. The infiltrate showed numerous eosinophils, histiocytoid cells, lymphocytes, and large mononuclear cells with atypical hyperchromatic nuclei. Most of the lymphocytes and large mononuclear cells with atypical nuclei marked with UCHL-1 (T-cell marker). The histiocytoid cells marked with S-100 and were dendritic both in the epidermis and the dermis. Eosinophilic histiocytosis appears to differ from classic lymphomatoid papulosis. It presents with recurrent papules and nodules associated with marked pruritus. Eosinophilic histiocytosis uniformly has more eosinophils and does not have the reed-sternberg cells often observed in lymphomatoid papulosis type A. Eosinophilic histiocytosis does not have cells that mark with Ki-1 and shows numerous S-100-positive histiocytoid cells that are most likely langerhans cells, unlike lymphomatoid papulosis. However, eosinophilic histiocytosis may be an unusual Ki-1-negative variant of lymphomatoid papulosis with histopathologic changes not typical of type A or type B. In addition, eosinophilic histiocytosis lacks multinucleated histiocytes and the atypical histiocyte with a reniform nucleus, findings that are characteristic of histiocytosis X. Further studies are needed to define the pathophysiology and prognosis of this apparently distinct entity more accurately.- - - - - - - - - - ranking = 2keywords = dermis (Clic here for more details about this article) |
3/4. lymphomatoid papulosis associated with pregnancy.We report a case of lymphomatoid papulosis which developed in a 29-year-old pregnant woman. She had numerous papules scattered over the inner aspect of the left thigh. histology of the biopsy specimen demonstrated an atypical mononuclear cell infiltration of the dermis. Spontaneous regression of the lesions occurred after termination of gestation. A possible effect of hormonal changes and alterations in T lymphocyte activity during pregnancy on the occurrence of lymphomatoid papulosis is discussed. In 1968, Macaulay introduced the term lymphomatoid papulosis for a chronic self-healing skin lesion which was clinically benign and histologically malignant. Clinically, lymphomatoid papulosis consists of involuting and recurring papules, plaques and nodules. Histopathologically, the lesion is characterized by an atypical lymphoid infiltrate which resembles malignant lymphoma. Immunohistochemically, the atypical lymphoid cells bear T-cell markers and are characterized by the expression of Ki-1 or CD30. We describe the first case of typical lymphomatoid papulosis which developed during pregnancy.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
4/4. Involvement of the tongue by lymphomatoid papulosis.We report on a case of lymphomatoid papulosis (LyP) with involvement of the tongue. The patient was a 34-year-old Japanese man. Three reddish, centrally depressed, slightly elevated nodules were evident on the dorsal tongue, along with lesions elsewhere on the skin. One of them was biopsied and exhibited a superficial and deep, perivascular and interstitial mixed cellular infiltrate including atypical lymphoid cells, lymphocytes, neutrophils, and histiocytes. The patient also showed rhythmical recurrence of reddish papules and ulcerated nodules on the trunk, extremities, and anogenital area. Histologically, these papules showed a dense, wedge-shaped mixed cellular infiltrate in the dermis, which included medium and large atypical lymphoid cells, lymphocytes, neutrophils, and histiocytes. Immunoperoxidase staining for CD30 was positive in the cell membrane and cytoplasm of the atypical cells. We could not find other reports of LyP involving the tongue. Systemic treatment with interferon (INF)-alpha2a was dramatically effective in inhibiting recurrence of the eruption.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |