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Granulomatous eccrinotropic lymphomatoid papulosis.

A Neil Crowson1, Dmitry Y Baschinsky, Al Kovatich

  • 1Central Medical Laboratories, Winnipeg, Canada.

American Journal of Clinical Pathology
|May 23, 2003
PubMed
Summary
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This study identifies a new type of lymphomatoid papulosis with distinctive eccrine coil involvement. This condition, characterized by granulomatous inflammation, does not appear to progress to lymphoma in patients.

Area of Science:

  • Dermatopathology
  • Immunohistochemistry
  • Molecular Biology

Background:

  • Lymphomatoid papulosis is a rare condition with diverse clinical and histological presentations.
  • A novel variant characterized by eccrine coil involvement and granulomatous inflammation is described.

Purpose of the Study:

  • To characterize a novel variant of lymphomatoid papulosis.
  • To differentiate this variant from other cutaneous conditions that may cause diagnostic confusion.

Main Methods:

  • Histopathological examination including light microscopy and immunohistochemistry (CD2, CD3, CD4, CD5, CD7, CD8, CD30).
  • T-cell receptor gamma chain gene rearrangement analysis using polymerase chain reaction-single-stranded conformational polymorphism.
  • Clinical follow-up of patients.

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Main Results:

  • Two cytomorphologic patterns were identified: large cell dominant and small cell lymphocyte-rich.
  • Clonal T-cell receptor gamma chain gene rearrangement was detected in 4 out of 5 lymphocyte-dominant cases.
  • No lymphomas developed during an average 6-year follow-up period.

Conclusions:

  • This variant of lymphomatoid papulosis is defined by eccrine coil and cutaneous nerve involvement, granulomatous inflammation, and a predominantly lymphocytic infiltrate.
  • Clinical features such as pruritus, younger age at diagnosis, and an indolent course are suggestive.
  • Distinguishing this entity from discoid lupus erythematosus, Jessner lymphocytic infiltrate, subcutaneous T-cell lymphoma, and arthropod bite reactions is crucial.