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Nodular B-Cell Cutaneous Lymphoid Infiltrate With Limited Tissue for Molecular Evaluation: A Case Highlighting
Sri Naidnur1, Coral Martes-Villalobos2, Sonia A Neave3
1Dermatology, Oasis Dermatology Group, McAllen, USA.
Insights
Cutaneous lymphoid infiltrates pose diagnostic challenges, mimicking lymphoma. This case highlights how insufficient tissue for molecular testing can lead to diagnostic uncertainty and varied management approaches for skin lesions.
Area of Science:
- Dermatology
- Pathology
- Oncology
Background:
- Cutaneous lymphoid infiltrates are challenging to diagnose, often mimicking lymphoma.
- Molecular testing (gene rearrangement studies) can aid in assessing clonality but isn't always feasible.
- Diagnostic uncertainty can arise from limited tissue samples for analysis.
Abstract:
Cutaneous lymphoid infiltrates can mimic lymphoma and often present a diagnostic challenge. While gene rearrangement studies may help assess clonality, they are not always feasible in routine practice. We present a case of a nodular B-cell-predominant lymphoid infiltrate in the left proximal arm for which molecular testing could not be performed due to insufficient tissue. Histopathology and immunohistochemistry favored a reactive process, but diagnostic uncertainty remained. Management differed between providers. Dermatopathology recommended clinical monitoring, while the treating dermatologist referred the patient to hematology/oncology for further evaluation. The patient underwent a systemic workup but was ultimately lost to follow-up. This case highlights the limitations of tissue sampling, variability in management, and the importance of clinicopathologic correlation in cutaneous lymphoid infiltrates.