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Cutaneous lymphoid hyperplasia: a lymphoproliferative continuum with lymphomatous potential
Minakshi Nihal1, Debra Mikkola, Nancy Horvath
1Department of Dermatology, University of Wisconsin and the Middleton Department of Veterans Affairs Medical Center, Madison, WI, USA.
Human Pathology
|June 27, 2003
Summary
Clonal overgrowth is common in cutaneous lymphoid hyperplasia (CLH), suggesting it is a transitional state that can lead to cutaneous lymphoma. This study found a high prevalence of clonality in CLH, linking it to lymphoma development.
Area of Science:
- Dermatology
- Hematology
- Oncology
Background:
- Cutaneous lymphoid hyperplasia (CLH) is considered a benign condition, potentially at the start of a spectrum of lymphoproliferative disorders.
- Clonal CLH represents an intermediate state, possibly progressing to overt cutaneous lymphoma.
Purpose of the Study:
- To determine the prevalence of dominant clonality in CLH cases.
- To assess the risk of lymphoma development in patients with CLH.
Main Methods:
- Investigated immunohistology and clonality in 44 CLH patients using fresh-frozen samples.
- Utilized polymerase chain reaction (PCR) assays for immunoglobulin heavy chain (IgH) and T-cell receptor (TCR)-gamma gene rearrangements.
- Classified cases into typical mixed B-cell/T-cell CLH and T-cell-rich CLH (T-CLH).
Main Results:
- 61% of CLH cases (27/44) exhibited clonal overgrowth (12 IgH+, 13 TCR+, 2 IgH+/TCR+).
- Two cases (4%) progressed to cutaneous B-cell lymphoma, both presenting with regional lesions.
- Clonality was observed in both B- and T-cell lineages.
Conclusions:
- Dominant clonality is common in CLH, supporting its role as a precursor to cutaneous lymphoma.
- The findings highlight the link between CLH and lymphoma, involving both B and T cell types.
- High clonality prevalence may be due to sensitive PCR assays and patient selection.
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