Treatment of primary cutaneous B-cell lymphomas of follicle center cell origin: a clinical follow-up study of 55 patients treated with radiotherapy or polychemotherapy.

PURPOSE: Primary cutaneous follicle center cell lymphomas (PCFCCL) are a distinct group of cutaneous B-cell lymphomas with a favorable prognosis after radiotherapy (RT) or polychemotherapy (PCT). In the literature, conflicting data exist regarding the efficacy and the relapse rate of both treatment modalities. In the present study, treatment results and follow-up data of a large group of PCFCCL are evaluated. PATIENTS AND METHODS: Fifty-five patients with a PCFCCL who presented with skin lesions on either the head (n = 12), the trunk (n = 35), or lower legs (n = 8), and who were initially treated with RT (40 cases) or PCT (15 cases) were studied. RESULTS: RT resulted in a complete remission in all 40 cases. Eight cases relapsed and three of these patients died as a result of their lymphoma. The estimated 5-year survival was 89%. Four of eight relapses and all three lymphoma-related deaths occurred in the group of patients presenting with tumor(s) on the lower legs. Treatment with cyclophosphamide, doxorubicin vincristine, and prednisone (CHOP) or cyclophosphomide, vincristine, and prednisone (COP) resulted in a complete remission in 14 of 15 cases. All four cases treated with COP relapsed, whereas only two of 11 patients treated with CHOP had a relapse. The estimated 5-year survival rate of the PCT group was 93%. CONCLUSION: Both RT and CHOP PCT are highly effective modes of treatment for PCFCCL. In localized PCFCCL, RT is the treatment of choice. In patients with multiple tumors involving anatomic nonrelated parts of the skin, CHOP rather than COP PCT is the preferred mode of treatment. PCFCCL on the lower legs, a subgroup that characteristically occur in elderly patients, have a higher relapse rate and a less favorable prognosis than PCFCCL presenting on the head or trunk.

Cutaneous pseudolymphomas: classification and differential diagnosis.

Cutaneous pseudolymphomas are benign hyperplastic lymphoproliferative reactions that simulate cutaneous malignant lymphomas clinically and/or histologically. The differentiation between cutaneous pseudolymphomas and primary cutaneous lymphomas is often very difficult, but is important because it has therapeutic consequences. The term pseudolymphoma does not refer to a specific disease, but to a heterogeneous group of pseudo-B-cell lymphomas and pseudo-T-cell lymphomas. In this article clinical and histological features of this group of disorders will be discussed and the differential diagnostic criteria, that have been used in the past decades to differentiate between cutaneous lymphomas and pseudolymphomas will be critically evaluated.

Cutaneous immunocytomas: a clinicopathologic study of 26 cases.

The clinical and histological features of 16 patients with a primary cutaneous immunocytoma and 10 patients with a secondary cutaneous immunocytoma are reported. In all cases the diagnosis was based on the presence of monotypic plasma cells or lymphoplasmacytoid cells. Our data show that primary cutaneous immunocytomas are a distinct type of cutaneous lymphoma, characterized by (a) the presence of solitary or localized skin lesions (13 of 16 cases); (b) preferential localization on arms and legs (15 of 16 cases); (c) excellent response to local treatment (15 of 16 cases) and (d) a favourable prognosis. Histologically, these primary cutaneous immunocytomas are characterized by the presence of nodular or diffuse infiltrates with monotypic lymphoplasmacytoid/plasma cells located at the periphery of the infiltrates. Important clinical and histological differences were noted between primary and secondary immunocytomas. In the latter group more widespread skin disease was seen, often in the presence of paraproteins and/or autoimmune diseases. In contrast with the peripheral localization of the monotypic cells in primary cutaneous immunocytomas the monotypic lymphoplasmacytoid/plasma cells in secondary immunocytomas formed diffuse infiltrates or these cells were found dispersed throughout the infiltrate. There were no differences in clinical presentation or course between the different subtypes of cutaneous immunocytomas (lymphoplasmacytic, lymphoplasmacytoid and polymorphic immunocytomas). The differential diagnosis between primary cutaneous immunocytomas and cutaneous plasmacytomas, primary follicular centre cell lymphomas and cutaneous 'pseudolymphomas' is discussed.

[Diagnosis and classification of cutaneous pseudolymphoma. Historical review and perspectives]. / Diagnostic et classification des pseudolymphomes cutanés. Revue historique et perspectives.

Cutaneous pseudolymphomas are benign hyperplastic lymphoproliferative reactions that simulate cutaneous malignant lymphomas clinically and/or histologically. The differentiation between cutaneous pseudolymphomas and primary cutaneous lymphomas is often very difficult, but is important because it may have therapeutic consequences. The term pseudolymphoma does not refer to a specific disease, but to a heterogeneous group of pseudo-B-cell lymphomas and pseudo-T-cell lymphomas. In this review the definitions and classification of cutaneous pseudo-B-cell lymphomas and pseudo-T-cell lymphomas will be discussed, with emphasis on the changing concepts that have resulted from the introduction of new diagnostic methods. The various differential diagnostic criteria that have resulted from these concepts will be presented.

Oral etoposide in the treatment of cutaneous large-cell lymphomas. A preliminary report of four cases.

The favourable results of oral etoposide as single-agent therapy in four patients with a cutaneous lymphoma other than mycosis fungoides are reported. In all cases other chemotherapeutic options were limited because of prior chemotherapy or the age of the patients. Therapy with etoposide resulted in an initial complete remission in all patients, and was associated with minimal side-effects.

Cutaneous pseudo-T-cell lymphomas. A clinicopathologic study of 20 patients.

The histologic features of 20 patients with cutaneous pseudo-T-cell lymphomas other than actinic reticuloid and lymphomatoid papulosis were investigated. Two histologic types of cutaneous pseudo-T-cell lymphomas were designated. The band-like (MF-like) pattern that simulated mycosis fungoides (MF) and a nodular pattern that mimicked cutaneous T-cell lymphomas (CTCL) other than MF. Both patterns showed histologic features that generally are not found in CTCL and thus may be helpful in the differential diagnosis from CTCL. However, at present the differential diagnosis between pseudo-T-cell lymphomas and CTCL should be based on a combination of clinical and histologic data.

The significance of Leu 8 negative T cells in lymphoid skin infiltrates: malignant transformation, selective homing or T-cell activation?

The expression of Leu 8 was studied on skin biopsies from a large group of patients with benign and malignant skin disorders and correlated with the expression of T-cell differentiation antigens and activation markers. The effect of in vitro stimulation of peripheral blood T cells and T-cell subsets on the expression of Leu 8 antigen was also determined. In all the skin diseases studied an inverse relationship was found between the proportions of cells expressing Leu 8 and HLA-DR. A deficiency of Leu 8 positive cells was not specific for mycosis fungoides, but was also found in several reactive dermatoses. Stimulation of peripheral blood cells with phytohaemagglutinin (PHA), concanavalin A (Con A), and anti-CD3-PMA resulted in a considerable decrease of Leu 8 antigen expression on day 3 in both CD4+ and CD8+ T cells. These data suggest that the low proportion of Leu 8+ T cells in mycosis fungoides and several reactive skin disorders is not related to malignant transformation or selective homing of Leu 8- T cells, but probably results from local T-cell activation.

Differentiation between lymphadenosis benigna cutis and primary cutaneous follicular center cell lymphomas. A comparative clinicopathologic study of 57 patients.

The authors report the clinical and histologic features of 22 cases of lymphadenosis benigna cutis (LBC) and 35 cases of primary cutaneous follicular center cell (FCC) lymphoma. The differential diagnostic accuracy of criteria generally used for differentiating between benign and malignant cutaneous lymphoid infiltrates was evaluated. The clinical and histologic findings in these two groups showed many similarities. Except for a characteristic clinical presentation of patients with a primary cutaneous FCC lymphoma on the trunk, there was no single clinical or histologic criterion that reliably differentiated between both conditions in all cases. Follow-up data showed that only a small number of patients of the malignant group developed (four of 35 cases) or died of (two of 35 cases) systemic lymphoma. The favorable prognosis of this type of cutaneous lymphoma implies that lack of systemic lymphoma after a five-year follow-up cannot be used as a diagnostic criterion in retrospective studies.

Characterization of the dermal infiltrates in Jessner's lymphocytic infiltrate of the skin, polymorphous light eruption and cutaneous lupus erythematosus: differential diagnostic and pathogenetic aspects.

In the present study a comparative immunohistochemical study was performed on skin biopsies from of patients with Jessner's lymphocytic infiltration of the skin (LIS), polymorphous light eruption (PLE), discoid lupus erythematosus (DLE) and subacute cutaneous lupus erythematosus (SCLE) using a large panel of monoclonal antibodies against T cell differentiation antigens (CD3, CD4, CD8), immunoregulatory T cell subsets (CD7, 4B4, 2H4, Leu 8), B cells (CD22), activated cells CD25, OKT9, HLA-DR), Langerhans cells (CD1) and macrophages (Leu-M5). The results showed many similarities between LIS and PLE. The most important differences between these conditions and CDLE/SCLE were the high proportions of cells reactive with monoclonal antibody Leu-8 and the absence of T cells expressing HLA-DR antigens in LIS and PLE, suggesting absence of local T cell activation in these conditions. The differential diagnostic and pathogenetic aspects of these findings will be discussed.

Immunohistochemical studies of lymphadenosis benigna cutis occurring in a tattoo.

We report the development of a lymphoproliferative reaction in the red areas of a tattoo in a 53-year-old man. The results of histologic and immunohistochemical studies were consistent with a diagnosis of lymphadenosis benigna cutis. Patch tests showed a strong, delayed-type hypersensitivity to several mercury products. The pathogenetic mechanisms operative in the development of this reaction are discussed.

Tzanck smear in diagnosing genital herpes.

In 126 patients with anogenital lesions, in which herpes simplex virus (HSV) infection was suspected or included in the differential diagnosis, the results of cytodiagnosis of herpetic infection (Tzanck smear) were compared with virus culture. Cervical lesions were excluded from this study. HSV infection was proved by culture in 78 patients and was absent or non-active in 41 patients. Excluded from this study were seven patients who did not yield the virus on culture but had positive Tzanck smear results from three investigators. The characteristic cytopathic effect of herpetic infection was found in 78 patients who yielded HSV on culture. Tzanck smear sensitivity for skin lesions was 79% and for mucous membrane lesions was 81% in men and 52% in women. Tzanck smear specificity for the 41 patients without herpetic infection proved by virus culture was 93%. Differences in sensitivity and specificity between the results found by three investigators (double blind screening) were not significant. The Tzanck smear is reliable, inexpensive, and easy and quick to perform; it is suitable for office diagnosis because it does not require a specialised laboratory.