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International Journal of Surgery Case... Jul 2023Primary central nervous system (CNS) lymphomas (PCNSLs) comprise a heterogeneous subset of intracranial disorders, predominantly of the intraparenchymal high-grade...
INTRODUCTION AND IMPORTANCE
Primary central nervous system (CNS) lymphomas (PCNSLs) comprise a heterogeneous subset of intracranial disorders, predominantly of the intraparenchymal high-grade non-Hodgkin's lymphoma. Intracranial pseudolymphoma represents an exceedingly rare entity; as few as 3 reports in the English literature. We describe the first multiple large intracranial pseudolymphomata leading to increased intracranial pressure, visual loss, and recurrence during a short while. It also represents the first report of intracranial pseudolymphoma presented as a skull base tumor.
CASE PRESENTATION
We describe a 67-year-old female suffering from left-sided loss of visual acuity, headache, nausea, vomiting, and improper balance. Axial brain computed tomography (CT) scan revealed an isodense anterior interhemispheric mass lesion with surrounding edema in both frontal lobes. T1 and T2 weighted magnetic resonance imaging (MRI) and T1 weighted with gadolinium injection revealed two extra-axial isointense dural-based mass lesions with homogenous enhancement compressing both frontal lobes. The morphologic findings favored B cell pseudolymphoma and meningeal B cell lymphoid hyperplasia. One year later, she developed headaches, disorientation, and progressive meaningless speech lasting 2 months. Subsequent MRI demonstrated the rapid growth of the lesion of the lesser sphenoid wing and recurrence of the lesion at the same site of surgery, thereby undergoing revision surgery in which both tumors were maximally resected using a pterional approach.
CLINICAL DISCUSSION
Intracranial pseudolymphoma remains exceedingly rare, and despite its benign cellular nature, it may proliferate and recur quickly.
CONCLUSION
Intracranial pseudolymphoma should always be considered a rare but potentially differential diagnosis leading to the intraventricular lesion.
PubMed: 37384957
DOI: 10.1016/j.ijscr.2023.108373 -
The Journal of Dermatology Feb 2022To identify clonal neoplastic cells in skin affected by B-cell lymphoma using skin flow cytometry (FCM) techniques, we investigated light-chain restriction using skin...
To identify clonal neoplastic cells in skin affected by B-cell lymphoma using skin flow cytometry (FCM) techniques, we investigated light-chain restriction using skin FCM with clonality assessed by polymerase chain reaction and light-chain restriction by in situ hybridization (ISH). We retrospectively analyzed 16 cases of B-cell lymphoma with cutaneous involvement: primary cutaneous diffuse large B-cell lymphoma, leg type (pcDLBCL-LT) (n = 7), DLBCL-not otherwise specified (DLBCL-NOS) (n = 6), primary cutaneous follicle center lymphoma (pcFCL) (n = 1), and follicular lymphoma (n = 2), as well as cutaneous B-cell pseudolymphoma (n = 9). Results of skin FCM light-chain restriction analyses were compared with immunoglobulin H (IgH) gene rearrangement and κ/λ ISH findings. Skin FCM detected light-chain restriction in 11 of 14 B-cell lymphoma patients but none of the B-cell pseudolymphoma patients. The sensitivity of skin FCM for distinguishing B-cell lymphoma and B-cell pseudolymphoma was 79%, and the specificity was 100%. Eleven of 13 B-cell lymphoma patients exhibited gene rearrangement (sensitivity 85%), whereas six of seven pseudolymphoma patients were negative (specificity 86%). ISH was positive in three of 16 B-cell lymphoma cases (sensitivity 19%) but none of the B-cell pseudolymphoma cases (specificity 100%). ISH sensitivity was 29% for pcDLBCL-LT, 17% for DLBCL-NOS, and 0% for pcFCL and follicular lymphoma. Skin FCM therefore appears to be more sensitive than ISH in detecting light-chain restriction in DLBCL and follicular lymphoma, and as sensitive as IgH gene rearrangement analysis in detecting clonality. Skin FCM is thus a promising diagnostic tool for identifying monoclonal neoplastic B-cell populations.
Topics: Flow Cytometry; Gene Rearrangement; Humans; Immunophenotyping; Lymphoma, Large B-Cell, Diffuse; Pseudolymphoma; Retrospective Studies
PubMed: 34263482
DOI: 10.1111/1346-8138.16057 -
Dermatologic Therapy Jul 2019To explore and compare the clinical presentations and pathologic features of cutaneous pseudolymphomas (CPL) with primary cutaneous lymphomas. Review literature in order... (Review)
Review
To explore and compare the clinical presentations and pathologic features of cutaneous pseudolymphomas (CPL) with primary cutaneous lymphomas. Review literature in order to improve the treatment of CPL. Six cases of CPLs were collected. The clinical, pathologic, and immunohistochemical features were performed and analyzed in Peking Union Medical College Hospital in 2018. Of six patients, the distributions and clinical manifestations of skin lesions are varied. The pathologic features consisted of atypical prominent lymphocytes infiltration. Of them, two cases imitated mycosis fungoides, one case mimicked primary cutaneous aggressive pidermotropic CD8+ cytotoxic T-cell lymphoma, one case was diagnosed as Jessner-Kanof lymphocyte infiltration and two cases primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. With respect to etiology, one was result from insects bite and the others were on account of drugs. All cases were treated with systemic or local glucocorticoid. The skin lesions and systemic symptoms showed notable improvement after treatment. Follow-up visits were 2 years, half a year, and months, respectively, without relapse. These unique types of CPL were similar to cutaneous lymphomas in clinical manifestation and pathology. They were all sensitive to the treatment of externally or orally using glucocorticoid. The prognosis is generally good but needs long-term follow-up.
Topics: Adolescent; Adult; Aged, 80 and over; Female; Glucocorticoids; Humans; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Pseudolymphoma; Skin Neoplasms
PubMed: 30589489
DOI: 10.1111/dth.12807 -
Anais Brasileiros de Dermatologia 2022
Topics: Humans; Pseudolymphoma; Skin Diseases; Skin Neoplasms
PubMed: 35853772
DOI: 10.1016/j.abd.2020.11.019 -
Cureus Mar 2023Pseudolymphoma (PSL) of the orbit is a benign lymphoid hyperplasia (LH). It is a rare disease with an extensive range of known causative agents. LH is further classified...
Pseudolymphoma (PSL) of the orbit is a benign lymphoid hyperplasia (LH). It is a rare disease with an extensive range of known causative agents. LH is further classified into "reactive" (RLH) and "atypical" (ALH) types. It clinically presents as a single or a few plaques and/or nodular lesions, particularly on the head, neck, and upper trunk. It must be differentiated from orbital malignant lymphoma. In this report, we present a case of a 58-year-old Pakistani female with an asymptomatic recurrent right periorbital swelling for three years. It was clinically diagnosed as an angiotensin-converting enzyme (ACE) inhibitor-induced angioedema as it responded to stopping the ACE inhibitor; however, after four months, the patient again started to develop right periorbital swelling. An incisional biopsy revealed perivascular and periadnexal infiltration of lymphocytes, plasma cells, and a few neutrophils along with pigmentary incontinence. The formation of multiple lymphoid follicles and infiltration by monomorphic lymphoid cells in deeper skeletal muscle fibers were also observed. Immunohistochemistry (IHC) showed polyclonality and low Ki-67 labeling (20%), corresponding to periorbital RLH. Our objective in this study is to highlight the importance of considering PSL as a differential diagnosis in periorbital swelling. We also suggest that recurrent angioedema may lead to PSL.
PubMed: 37073202
DOI: 10.7759/cureus.36270 -
Journal of Clinical Neuroscience :... Aug 2020Intracranial pseudolymphoma is a rare entity. We report the case of a 44 year old female who presented with headaches and was noted to have a right lateral ventricular...
Intracranial pseudolymphoma is a rare entity. We report the case of a 44 year old female who presented with headaches and was noted to have a right lateral ventricular lesion on a background history of Burkitt's lymphoma. She underwent biopsy of said lesion and was found to have benign reactive lymphoid tissue. This is the third reported case in literature of intracranial pseudolymphoma and the first reported intraventricular lesion.
Topics: Adult; Biopsy; Burkitt Lymphoma; Cerebral Ventricles; Diagnosis, Differential; Female; Humans; Pseudolymphoma
PubMed: 32417128
DOI: 10.1016/j.jocn.2020.04.082 -
Acta Dermatovenerologica Croatica : ADC Nov 2022Dear Editor, Pilonidal cyst disease is a common, acquired, inflammatory disease predominantly affecting the natal clefts of the buttocks (1,2). The disease has a...
Dear Editor, Pilonidal cyst disease is a common, acquired, inflammatory disease predominantly affecting the natal clefts of the buttocks (1,2). The disease has a predilection for men, with a male-to-female ratio of 3-4:1. Patients are generally young, towards the end of second decade of life. Lesions are initially asymptomatic, while the development of complications such as abscess formation is associated with pain and discharge (1). Patients with pilonidal cyst disease may present to dermatology outpatient clinics, especially when the disease is asymptomatic. Herein we report the dermoscopic features of four cases of pilonidal cyst disease encountered in our dermatology outpatient clinic. Four patients who presented to our dermatology outpatient department for evaluation of a solitary lesion on buttocks were diagnosed with pilonidal cyst disease based on clinical and histopathological examination. All patients were young men and presented with solitary, firm, pink, nodular lesions in the region in proximity to the gluteal cleft (Figure 1, a, c, e). Dermoscopy of the first patient revealed a red structureless area in the central part of the lesion, consistent with ulceration. Additionally, white lines reticular as well as glomerular vessels were present at the periphery on the pink homogenous background (Figure 1, b). In the second patient, a yellow structureless central ulcerated area was surrounded by linearly arranged multiple dotted vessels at the periphery on a homogenous pink background (Figure 1, d). In the third patient, dermoscopy revealed a central yellowish structureless area with peripherally arranged hairpin and glomerular vessels (Figure 1, f). Lastly, similar to the third case, dermoscopic examination of the fourth patient showed a pink homogenous background with yellow and white structureless areas and peripherally arranged hairpin and glomerular vessels (Figure 2). Demographics and clinical features of the four patients are summarized in Table 1. Histopathology of all our cases revealed epidermal invagination and sinus formation, free hair shafts, and chronic inflammation with multinuclear giant cells. Histopathological slides of the first case can be seen in Figure 3 (a-b). All patients were referred to general surgery for treatment. The current knowledge pertaining to dermoscopy of pilonidal cyst disease is scarce in the dermatologic literature, and was previously evaluated in only two cases. Similar to our cases, the authors reported the presence of a pink-colored background, radial white lines, central ulceration, and multiple peripherally arranged dotted vessels (3). The dermoscopic features of pilonidal cysts differ from other epithelial cysts and sinuses. As for epidermal cysts, the presence of punctum and an ivory-white background color have been reported as characteristic dermoscopic findings (4,5). In addition, unruptured epidermal cysts reveal arborizing telangiectasia, while the ruptured epidermal cysts show peripheral linear branched vessels (4,5). A peripheral brown rim, linear vessels, and yellow homogenous background of the entire lesion have been reported as dermoscopic features of steatocystoma multiplex as well as milias (5). Of note, other cystic lesions mentioned above are typified by linear vessels, whereas pilonidal cysts present dotted, glomerular, and hairpin vessels. Pilonidal cyst disease must also be considered in the differential diagnosis of pink nodular lesions, along with amelanotic melanoma, basal cell carcinoma, squamous cell carcinoma, pyogenic granuloma, lymphoma, and pseudolymphoma (3). Based on our cases and the two cases in the literature, pink background, central ulceration, peripherally arranged dotted vessels, and white lines seem to be common dermoscopic features of pilonidal cyst disease. Our observations demonstrate that central yellowish structureless areas along with peripheral hairpin and glomerular vessels are also among the dermoscopic features of pilonidal cyst disease. In conclusion, pilonidal cysts can be easily differentiated from other skin tumors by the aforementioned dermoscopic features, and the diagnosis in patients clinically suspected of having pilonidal cyst can be supported by dermoscopy. However, there is need for further studies in order to better characterize typical dermoscopic features of this disease and their frequency.
Topics: Humans; Male; Female; Pilonidal Sinus; Epidermal Cyst; Dermoscopy; Skin Neoplasms; Skin Diseases
PubMed: 36812282
DOI: No ID Found -
Italian Journal of Dermatology and... Apr 2024Over the few last decades, dermoscopy has become an invaluable and popular imaging technique that complements the diagnostic armamentarium of dermatologists, being... (Review)
Review
INTRODUCTION
Over the few last decades, dermoscopy has become an invaluable and popular imaging technique that complements the diagnostic armamentarium of dermatologists, being employed for both tumors and inflammatory diseases. Whereas distinction between neoplastic and inflammatory lesions is often straightforward based on clinical data, there are some scenarios that may be troublesome, e.g., solitary inflammatory lesions or tumors superimposed to a widespread inflammatory condition that may share macroscopic morphological findings.
EVIDENCE ACQUISITION
We reviewed the literature to identify dermoscopic clues to support the differential diagnosis of clinically similar inflammatory and neoplastic skin lesions, also providing the histological background of such dermoscopic points of differentiation.
EVIDENCE SYNTHESIS
Dermoscopic differentiating features were identified for 12 relatively common challenging scenarios, including Bowen's disease and basal cell carcinoma vs. psoriasis and dermatitis, erythroplasia of Queyrat vs. inflammatory balanitis, mammary and extramammary Paget's disease vs. inflammatory mimickers, actinic keratoses vs. discoid lupus erythematosus, squamous cell carcinoma vs. hypertrophic lichen planus and lichen simplex chronicus, actinic cheilitis vs. inflammatory cheilitis, keratoacanthomas vs. prurigo nodularis, nodular lymphomas vs. pseudolymphomas and inflammatory mimickers, mycosis fungoides vs. parapsoriasis and inflammatory mimickers, angiosarcoma vs granuloma faciale, and Kaposi sarcoma vs pseudo-Kaposi.
CONCLUSIONS
Dermoscopy may be of aid in differentiating clinically similar inflammatory and neoplastic skin lesions.
Topics: Dermoscopy; Humans; Diagnosis, Differential; Skin Neoplasms; Dermatitis; Skin Diseases; Psoriasis
PubMed: 38650495
DOI: 10.23736/S2784-8671.24.07825-3 -
Journal of Cutaneous Pathology Mar 2024Syphilis can mimic, clinically and microscopically, many other diseases. By microscopy, typically syphilis presents with plasma cell infiltration, admixed with...
Syphilis can mimic, clinically and microscopically, many other diseases. By microscopy, typically syphilis presents with plasma cell infiltration, admixed with lymphocytes and macrophages, in lichenoid and/or perivascular/perineural distribution pattern. When exuberant, this inflammatory infiltrate can mimic a lymphoproliferative disorder (LPD), notably plasma cell neoplasia or lymphoma. To date, about 12 cases of secondary syphilis, all but one in extraoral location, suggesting initially a LPD, have been published. Here, to our knowledge, we report an unusual case of intraoral primary syphilis initially suggesting LPD, notably lymphoid hyperplasia (pseudolymphoma); however, mucosa-associated lymphoid tissue (MALT) lymphoma and follicular lymphoma could not be disregarded. Polyclonality of plasma cells on immunohistochemistry, in strict clinical correlation, was essential to arrive at the correct diagnosis.
Topics: Humans; Syphilis; Lymphoproliferative Disorders; Lymphoma, B-Cell, Marginal Zone; Lymphocytes; Diagnosis, Differential
PubMed: 38084767
DOI: 10.1111/cup.14567 -
Journal of Cutaneous Pathology Dec 2022T-cell-rich angiomatoid polypoid pseudolymphoma (TRAPP) and inflammatory lobular hemangioma (ILH) encompass a spectrum of cutaneous vascular lesions in which a prominent... (Comparative Study)
Comparative Study
BACKGROUND
T-cell-rich angiomatoid polypoid pseudolymphoma (TRAPP) and inflammatory lobular hemangioma (ILH) encompass a spectrum of cutaneous vascular lesions in which a prominent lymphoplasmacytic component may impart a pattern highly reminiscent of low-grade cutaneous lymphoma (pseudolymphoma). Epithelioid hemangioma, including its most common variant angiolymphoid hyperplasia with eosinophilia (ALHE), is a distinct entity associated with FOS and/or FOSB expression detected by immunohistochemistry (IHC). These entities can show significant morphological overlap.
METHODS
We performed IHC for FOSB, FOS, and lymphoid markers in a series of TRAPP/ILH and ALHE.
RESULTS
We identified 13 cases of ILH/TRAPP, which showed a predominance in CD8 T-cells (CD8>CD4: 11/13) while FOSB and FOS were expressed in 36% (4/11) and 27% (3/11) of cases, respectively. ALHE (n = 9) showed a predominance in CD4 T-cell (67%) with FOSB and FOS co-expression in 78% (seven of nine) of the cases.
CONCLUSION
We showed, based on FOS and/or FOSB immunohistochemical expression, that there is a possible link between ILH/TRAPP and epithelioid hemangioma/ALHE. The use of FOS and FOSB IHC in the routine diagnostic setting of cutaneous vascular lesions will help to redefine cases of ILH/TRAPP as a subset of these may represent inflammatory variants of epithelioid hemangioma.
Topics: Humans; Angiolymphoid Hyperplasia with Eosinophilia; Biomarkers; CD8-Positive T-Lymphocytes; Granuloma, Pyogenic; Hemangioma; Immunohistochemistry; Proto-Oncogene Proteins c-fos; Pseudolymphoma
PubMed: 36008878
DOI: 10.1111/cup.14317