CD30 Positive Lymphomatoid Drug Reactions
Constantin S Friedman, Neil Crowson, Cynthia C Magro. NYP-Weill Cornell Medical College, New York, NY; Regional Medical Laboratory, Tulsa, OK
Background: Atypical cutaneous lymphocytic infiltrates of the skin can be induced by drug therapy, defining the concept of the lymphomatoid drug reaction. The most common expression of the lymphomatoid drug reaction is one which resembles mycosis fungoides(MF) including the interstitial granulomatous variant of MF. The latter has fallen under the appellation of drug associated reversible granulomatous T cell dyscrasia. The so called lymphomatoid vascular reaction has been described as a unique morphologic variant of lymphomatoid drug reaction. In this study we present a group of patients with a CD30+ lymphomatoid angiocentric drug reaction, a reaction pattern which closely resembles type A lymphomatoid papulosis.
Design: All cases were encountered in the routine dermatopathology practice of the authors. A total of 9 cases were encountered in which a diagnosis of CD30+ lymphomatoid drug reaction was confirmed based on the temporal association between lesional onset with initiation of drug therapy and subsequent resolution with drug cessation.
Results: The patients presented with a pruritic papular eruption. There were 5 women and 4 men ranging in age from 49 to 76 years of age. In each case, the biopsies demonstrated a similar morphology, namely a superficial angiocentric lymphocytc infiltrate containing many immunoblasts exhibiting variable atypia. Tissue eosinophilia and supervening eczematous changes in the overlying epidermis were not uncommon. In all cases, the angiocentric infiltrate was highlighted by CD3, CD30, and CD4. Cytotoxic protein granule expression or monoclonality were not observed. In all cases there was improvement or complete regression of the eruption upon drug modulation. The drugs were among those most commonly implicated in the lymphomatoid drug reactions, comprising statins (4 cases), ACE inhibitors especially linisopril (5 cases), calcium channel blockers (2 cases), chemotherapy agents (3 cases), HCV associated antiviral therapy (1 case) and antidepressants (1 case).
Conclusions: The CD30 positive lymphomatoid drug reaction poses a diagnostic challenge because of its close resemblance to lymphomatoid papulosis. Differences morphologically include the superficial confinement of the reaction, lack of cytotoxic protein expression amid the atypical immuoblastic cells, and supervening eczematous alterations in the epidermis. A role for combined iatrogenic and endogenous immune dysregulation including polypharmacy is likely important pathogenetically.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 84, Monday Morning