Eruption of lymphocyte recovery with atypical lymphocytes mimicking a primary cutaneous T-cell lymphoma: a series of 12 patients.

Hurabielle, Charlotte; Sbidian, Emilie; Beltraminelli, Helmut; Bouchindhomme, Brigitte; Chassagne-Clément, Catherine; Balme, Brigitte; Bossard, Céline; Delfau-Larue, Marie-Hélène; Wolkenstein, Pierre; Chosidow, Olivier; Cordonnier, Catherine; Toma, Andrea; Pautas, Cécile; Ortonne, Nicolas (2018). Eruption of lymphocyte recovery with atypical lymphocytes mimicking a primary cutaneous T-cell lymphoma: a series of 12 patients. Human pathology, 71, pp. 100-108. Elsevier 10.1016/j.humpath.2017.10.018

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Eruption of lymphocyte recovery (ELR) may occur during bone marrow aplasia after chemotherapies. We reviewed the clinical and pathologic features of 12 patients (male-female ratio, 7:5; median age, 61 years) with an atypical ELR histologically mimicking a primary cutaneous T-cell lymphoma such as Sézary syndrome or CD30+ T-cell lymphoproliferative disorder. All the patients displayed an erythematous maculopapular eruption on the trunk and the limbs associated with fever. All but one had received a polychemotherapy for an acute myeloid leukemia (n=10) or a urothelial carcinoma (n=1) before the occurrence of the skin eruption. One had an autoimmune lymphoproliferative syndrome causing chronic agranulocytosis requiring granulocyte colony-stimulating factor injection. In all patients, the skin eruption was associated with a slight increase of white blood cell count followed by bone marrow recovery within the next weeks. All skin biopsies showed a dermal perivascular lymphocytic infiltrate containing atypical medium- to large-sized CD3+, CD4+ and CD8+, CD25+, ICOS+, PD1- lymphocytes with a strong CD30 expression in most instances (n=10), suggesting the recruitment of strongly activated T cells in the skin. In 6 patients, a diagnosis of CD30+ lymphoproliferative disorder or Sézary syndrome was proposed or suspected histopathologically, and only the clinical context allowed the diagnosis of ELR with a peculiar presentation with atypical lymphocytes. We describe a series of patients with an unusual form of ELR characterized by the presence of atypical activated T cells in the skin. On a practical ground, pathologists should be aware of this distinctive and misleading presentation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology

UniBE Contributor:

Beltraminelli, Helmut

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0046-8177

Publisher:

Elsevier

Language:

English

Submitter:

Sandra Nyffenegger

Date Deposited:

10 Apr 2018 14:19

Last Modified:

10 Apr 2018 14:19

Publisher DOI:

10.1016/j.humpath.2017.10.018

PubMed ID:

29107664

Uncontrolled Keywords:

CD30+ lymphoproliferative disorder Cutaneous T-cell lymphoma Eruption of lymphocyte recovery Maculopapular rash Pseudolymphoma

BORIS DOI:

10.7892/boris.110539

URI:

https://boris.unibe.ch/id/eprint/110539

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