Subtil Cutaneous Lymphomas, An Issue of Surgical Pathology Clinics

1. Auflage 2014
ISBN: 978-0-323-27785-3
Verlag: Elsevier HealthScience EN
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band Volume 7-2, 169 Seiten

Reihe: The Clinics: Surgery

Knowledge of cutaneous lymphomas has been growing significantly as a result of important discoveries in immunology, molecular biology, and immunohistochemistry. Improved clinical pathologic correlation and follow-up data, as well as the synergistic collaboration among different lymphoma registries and specialists from several academic medical centers have greatly contributed to the understanding of the difficult field of cutaneous lymphoproliferative disorders. While these advances have increased understanding of skin lymphomas, they have also produced an extensive and sometimes confusing litany of articles, studies, and classification schemes. This issue on Cutaneous Lymphomas in Surgical Pathology Clinics provides an organized and updated review of this challenging topic by leading experts. It bridges critical knowledge gaps in the diagnosis of cutaneous lymphomas. Sezary Syndrome, Mycosis Fungoides and variants are presented along with B-cell, CD30, lymphoproliferative disorders among others. In addition to multiple clinical and microscopic images, tables and algorithms are presented to aid in diagnosis and staging. Beyond its usefulness to general pathologists, dermatopathologists, and hematopathologists, this information is intended to be helpful for dermatologists, hematologists/oncologists, fellows, and residents.

Autoren/Hrsg.

Subtil, Antonio

Inhaltsverzeichnis

1;Front Cover;1
2;Cutaneous Lymphomas
;2
3;copyright
;3
4;Contributors;4
5;Contents;6
6;Surgical Pathology Clinics
;8
7;Preface
;10
8;A General Approach to the Diagnosis of Cutaneous Lymphomas and Pseudolymphomas;12
8.1;Abstract;12
8.2;Key points;12
8.3;Overview;12
8.4;References;19
9;Mycosis Fungoides;20
9.1;Abstract;20
9.2;Key points;20
9.3;Overview;20
9.4;Clinical features;20
9.5;Diagnosis: microscopic features;24
9.6;Diagnosis: ancillary studies;30
9.7;Differential diagnosis;34
9.8;Prognosis;42
9.9;References;43
10;Mycosis Fungoides Variants;46
10.1;Abstract;46
10.2;Key points;46
10.3;Overview;46
10.4;Folliculotropic mycosis fungoides;47
10.4.1;Overview;47
10.4.2;Clinical Features;47
10.4.3;Diagnosis: Microscopic Features;47
10.4.4;Diagnosis: Ancillary Studies;51
10.4.5;Differential Diagnosis;51
10.4.6;Prognosis;51
10.5;Pagetoid reticulosis (Woringer-Kolopp disease);52
10.5.1;Overview;52
10.5.2;Clinical Features;52
10.5.3;Diagnosis: Microscopic Features;53
10.5.4;Diagnosis: Ancillary Studies;53
10.5.5;Differential Diagnosis;53
10.5.6;Prognosis;55
10.6;Granulomatous slack skin syndrome;55
10.6.1;Overview;55
10.6.2;Clinical Features;56
10.6.3;Diagnosis: Microscopic Features;56
10.6.4;Diagnosis: Ancillary Studies;56
10.6.5;Differential Diagnosis;56
10.6.6;Prognosis;58
10.7;Hypopigmented mycosis fungoides;58
10.7.1;Overview;58
10.7.2;Clinical Features;59
10.7.3;Diagnosis: Microscopic Features;59
10.7.4;Diagnosis: Ancillary Studies;59
10.7.5;Differential Diagnosis;60
10.7.6;Prognosis;60
10.8;Other rare variants of MF;60
10.9;References;64
11;Sézary Syndrome;68
11.1;Abstract;68
11.2;Key points;68
11.3;Overview;68
11.4;Clinical features;69
11.5;Diagnosis: microscopic features;70
11.6;Diagnosis: ancillary studies;73
11.7;Differential diagnosis;76
11.8;Prognosis;77
11.9;References;78
12;Cutaneous CD30-Positive Lymphoproliferative Disorders;80
12.1;Abstract;80
12.2;Overview;80
12.3;LyP;81
12.3.1;Overview;81
12.3.2;Diagnosis: Clinical Features;81
12.3.3;Diagnosis: Microscopic Features;82
12.3.4;Diagnosis: Ancillary Studies;85
12.3.5;Differential Diagnosis;89
12.3.6;Prognosis;91
12.4;Primary cutaneous anaplastic large-cell lymphoma;93
12.4.1;Overview;93
12.4.2;Clinical Features;94
12.4.3;Diagnosis: Microscopic Features;94
12.4.4;Diagnosis: Ancillary Studies;97
12.4.5;Differential Diagnosis;97
12.4.6;Prognosis;98
12.5;Borderline lesions;99
12.6;CD30 as prognostic marker and expression in other lymphomas;100
12.7;CD30 as therapeutic marker;100
12.8;References;101
13;CD30-Negative Cutaneous T-Cell Lymphomas Other than Mycosis Fungoides;106
13.1;Abstract;106
13.2;Key points;106
13.3;Overview;106
13.4;Subcutaneous panniculitis–like T-cell lymphoma;107
13.4.1;Overview;107
13.4.2;Clinical Features;107
13.4.3;Diagnosis: Microscopic Features;108
13.4.4;Diagnosis: Ancillary Studies;108
13.4.5;Differential Diagnosis;110
13.4.6;Prognosis;110
13.5;Extranodal NK/T-cell lymphoma, nasal type;110
13.5.1;Overview;110
13.5.2;Clinical Features;110
13.5.3;Diagnosis: Microscopic Features;110
13.5.4;Diagnosis: Ancillary Studies;110
13.5.5;Differential Diagnosis;111
13.5.6;Prognosis;111
13.6;Hydroa vacciniforme–like lymphoma;111
13.6.1;Overview;111
13.6.2;Clinical Features;111
13.6.3;Diagnosis: Microscopic Features;113
13.6.4;Diagnosis: Ancillary Studies;114
13.6.5;Differential Diagnosis;114
13.6.6;Prognosis;114
13.7;Primary cutaneous gamma-delta T-cell lymphoma;114
13.7.1;Overview;114
13.7.2;Clinical Features;114
13.7.3;Diagnosis: Microscopic Features;115
13.7.4;Diagnosis: Ancillary Studies;115
13.7.5;Differential Diagnosis;115
13.7.6;Prognosis;115
13.8;Primary cutaneous aggressive epidermotropic CD8-positive cytotoxic T-cell lymphoma (provisional entity);116
13.8.1;Overview;116
13.8.2;Clinical Features;116
13.8.3;Diagnosis: Microscopic Features;116
13.8.4;Diagnosis: Ancillary Studies;116
13.8.5;Differential Diagnosis;116
13.8.6;Prognosis;118
13.9;Primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoma (provisional entity);118
13.9.1;Overview;118
13.9.2;Clinical Features;118
13.9.3;Diagnosis: Microscopic Features;118
13.9.4;Diagnosis: Ancillary Studies;121
13.9.5;Differential Diagnosis;121
13.9.6;Prognosis;123
13.10;Primary cutaneous peripheral T-cell lymphoma, not otherwise specified;125
13.10.1;Overview;125
13.10.2;Clinical Features;125
13.10.3;Diagnosis: Microscopic Features;125
13.10.4;Diagnosis: Ancillary Studies;125
13.10.5;Differential Diagnosis;126
13.10.6;Prognosis;127
13.11;References;127
14;Primary Cutaneous B-Cell Lymphomas;130
14.1;Abstract;130
14.2;Overview;130
14.3;PCMZL;131
14.3.1;Overview/Definition;131
14.3.2;Clinical Features;131
14.3.3;Diagnosis: Microscopic Features;131
14.3.4;Diagnosis: Ancillary Studies;132
14.3.5;Differential Diagnosis;137
14.3.6;Prognosis;142
14.4;PCFCL;144
14.4.1;Overview/Definition;144
14.4.2;Clinical Features;144
14.4.3;Diagnosis: Microscopic Features;145
14.4.4;Diagnosis: Ancillary Studies;147
14.4.5;Differential Diagnosis;148
14.4.6;Prognosis;151
14.5;PCDLBCL-LT;151
14.5.1;Overview/Definition;151
14.5.2;Clinical Features;151
14.5.3;Diagnosis: Microscopic Features;151
14.5.4;Diagnosis: Ancillary Studies;151
14.5.5;Differential Diagnosis;153
14.5.6;Prognosis;157
14.6;Acknowledgments;158
14.7;References;158
15;Index;162

Leseproben

A General Approach to the Diagnosis of Cutaneous Lymphomas and Pseudolymphomas
Antonio Subtil, MD, [e-mail],     Yale Dermatopathology Laboratory, Yale School of Medicine, 15 York Street, LMP 5031, New Haven, CT 06520-8059, USA Abstract
Both pathology and dermatology rely heavily on a visual approach to learning, generating differential diagnoses, and making diagnoses. Pattern recognition and the development of diagnostic frameworks are essential elements in this process. In addition to images, several algorithms and summaries are presented in this article to provide a practical approach to the diagnosis of cutaneous lymphoproliferative disorders. The critical importance of clinical pathologic correlation is also emphasized. Keywords Cutaneous lymphomas Pseudolymphomas Skin T-cell B-cell Lymphoma Diagnosis Histopathology Dermis Epidermis Key points
• Both pathology and dermatology rely heavily on a visual approach to learning, generating differential diagnoses (DDx), and making diagnoses. • Pattern recognition and the development of diagnostic frameworks are essential elements in this process. • In addition to images, several tables and algorithms are presented in this article to provide a practical approach to the diagnosis of cutaneous lymphoproliferative disorders. • The critical importance of clinical pathologic correlation is also emphasized. Overview
This issue on “Cutaneous Lymphomas” in Surgical Pathology Clinics provides an organized and updated review of this challenging topic by an international team of experts and bridges critical knowledge gaps in the diagnosis of cutaneous lymphomas. In addition to multiple clinical and microscopic images, several tables are presented to aid in diagnosis and staging. Both common and rare entities are reviewed—mycosis fungoides (MF), unique clinicopathologic variants of MF, cutaneous CD30-positive lymphoproliferative disorders, T-cell lymphomas without clinical features of MF or CD30 expression, and cutaneous B-cell lymphomas. For all entities, careful correlation of clinical and histopathologic findings is essential to arrive at the correct diagnosis (Fig. 1).
Fig. 1 Clinical pathologic correlation is essential to the diagnosis of skin lymphoma (HE, original magnification ×600). Considering the heterogeneity and complexity of cutaneous lymphoproliferative disorders,1–3 this introductory article includes several tables and algorithms to provide a practical and logical approach to DDx based on different clinical findings (Fig. 2, Table 1) and histopathologic patterns (Boxes 1–6, Figs. 3–7). Within the differential list, each diagnostic possibility includes a link to a corresponding article for further information. In addition, it is important to recognize that several diseases (benign and malignant) may mimic cutaneous lymphomas. A comprehensive list of pseudolymphomas is provided in Box 7. Box 1   Differential diagnosis of large cell lymphoid infiltrate (>25%–30% large cells) • Large cell transformation of MF See the article by Pincus elsewhere in this issue. • LyP type C The histologic features of LyP type C and pcALCL as well as sALCL are identical. To separate these entities, integration of clinical presentation and staging results as well as phenotypic and genetic findings are mandatory. See the article by Kempf elsewhere in this issue. • Cutaneous anaplastic large cell lymphoma See the article by Kempf elsewhere in this issue. • Some cases of aggressive cytotoxic cutaneous lymphomas See the article by Willemze elsewhere in this issue. • Primary cutaneous peripheral T-cell lymphoma, unspecified See the article by Willemze elsewhere in this issue. • Primary cutaneous diffuse large B-cell lymphoma, leg type See the article by Sundram elsewhere in this issue. Abbreviations: LyP, lymphomatoid papulosis; pcALCL, primary cutaneous anaplastic large cell lymphoma; sALCL, systemic anaplastic large cell lymphoma. Box 2   Differential diagnosis of perifollicular accentuation (lymphoid infiltrate around hair follicles) • Folliculotropic MF See the article by Martinez-Escala and colleagues elsewhere in this issue. • Primary cutaneous marginal zone lymphoma See the article by Sundram elsewhere in this issue. • Some cases of lymphomatoid papulosis See the article by Kempf elsewhere in this issue. • Cutaneous pseudolymphoma: herpes folliculitis, pseudolymphomatous folliculitis, persistent arthropod bite reactions (see Box 7) Box 3   Differential diagnosis of cutaneous lymphoid infiltrate with frequent eosinophils • Folliculotropic MF See the article by Martinez-Escala and colleagues elsewhere in this issue. • Lymphomatoid papulosis type A See the article by Kempf elsewhere in this issue. • Cutaneous pseudolymphoma: lymphomatoid drug eruption, persistent arthropod bite reactions, scabies, exaggerated bitelike reactions in the setting of systemic hematologic disorders (see Box 7) Box 4   Differential diagnosis of CD8 expression • Lymphomatoid papulosis type D See the article by Kempf elsewhere in this issue. • Some cases of otherwise classical MF See the article by Pincus elsewhere in this issue. • Many cases of pagetoid reticulosis See the article by Martinez-Escala and colleagues elsewhere in this issue. • Some cases of cutaneous anaplastic large cell lymphoma See the article by Kempf elsewhere in this issue. • Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma See the article by Willemze elsewhere in this issue. • Subcutaneous panniculitis-like T-cell lymphoma See the article by Willemze elsewhere in this issue. • Many cases of cutaneous gamma/delta T-cell lymphoma See the article by Willemze elsewhere in this issue. • Indolent CD8+ lymphoid proliferation of the ear See the article by Willemze elsewhere in this issue. • Cutaneous pseudolymphoma: CD8+ infiltrates in the setting of advanced AIDS (see Box 7) Box 5   Differential diagnosis of CD30 expression • Lymphomatoid papulosis See the article by Kempf elsewhere in this issue. • Cutaneous anaplastic large cell lymphoma See the article by Kempf elsewhere in this issue. • Many (but not all) cases of large cell transformation of MF See the article by Pincus elsewhere in this issue. • Some cases of folliculotropic MF and pagetoid reticulosis See the article by Martinez-Escala and colleagues elsewhere in this...