Resolution of CD8+ lymphomatoid papulosis after surgical excision of the type AB-thymoma

Lymphomatoid papulosis (LyP) is a disease characterized by cyclic eruptions of papulonodular lesions, which undergo spontaneous healing. Lymphoid malignancies are present in 10%-15% of cases. The type AB thymoma is an epithelial neoplasm composed of both type A (lymphocyte-poor) and type B (lymphocyte-rich) areas. Chemokines are chemotactic cytokines, responsible for leukocyte motility and direct movement. Interactions between chemokines and their receptors have been correlated with homing of lymphoma cells to various tissues. We describe a patient whose type B LyP CD8 lesions completely resolved after surgical removal of type AB thymoma. The chemokine profile was similar in both tissues: thymus- and activation-regulated chemokine and CCR4 were focally positive in the thymoma. Thymus- and activation-regulated chemokine was positive in the epidermotropic cells and in the majority of the dermal lymphocytes in the LyP specimen, whereas CCR4 was focally positive in the dermal lymphocytes. Monokine induced by interferon-g (Mig) staining showed strong positivity in the dermal lymphocytes and in localized areas of the thymoma, but an immunostain for the Mig receptor (CXCR3) highlighted only a few scattered cells in both tissues (less than 3%). Both tissues were negative for regulated upon activation, normal T-cell expressed and secreted (RANTES) and CCR3. In summary, we report the association of a CD30-negative CD8-predominant LyP and a type AB thymoma, with similar chemokine profiles. The rarity of both conditions and the precise regression of LyP after removal of the thymoma argue against a coincidental observation. We recommend that a search for thymoma be included in the workup of LyP. Further chemokine profiling in other cases of LyP may assist in understanding their role in this disease.