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Heavy multinodular cutaneous lymphoid infiltrates: clinicopathologic features and B-cell clonality
K M Ceballos1, R D Gascoyne, M Martinka
1Department of Pathology, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.
Cutaneous lymphoid hyperplasia (CLH) and low-grade B-cell lymphoma can be difficult to distinguish. Heavy, multinodular skin infiltrates have an excellent prognosis, with multiple lesions predicting recurrence confined to the skin.
Area of Science:
- Dermatopathology
- Oncology
- Immunology
Background:
- Distinguishing cutaneous lymphoid hyperplasia (CLH) from low-grade B-cell lymphoma is challenging.
- The role of clonal B-cell populations in CLH prognosis is unclear.
Purpose of the Study:
- To investigate the correlation between clonal B-cell populations in heavy, multinodular lymphoid infiltrates and clinical presentation/outcome.
- To determine predictors of recurrence and systemic lymphoma development.
Main Methods:
- Histological analysis of 29 patients with heavy dermal lymphocytic infiltrates.
- Assessment of B-cell clonality using light-chain restriction and IgH-gene rearrangement PCR.
- Clinical follow-up for a mean of 80 months.
Main Results:
- Heavy, multinodular cutaneous infiltrates showed an excellent prognosis with no systemic lymphoma development.
- Multiple lesions at presentation predicted recurrent skin lesions (3/5 patients, 60% clonal).
- Solitary lesions had a low recurrence rate (4/24), with 38% showing clonality.
Conclusions:
- Heavy, multinodular CLH has an excellent prognosis.
- Multiple lesions predict recurrence confined to the skin.
- B-cell clonality does not correlate with clinical presentation, histology, or lymphoma development.
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