Cutaneous CD30 + Lymphoproliferative Disorders with CD8 Expression: A Clinicopathological Study of 18 Cases
Jose A Plaza, Andrew Feldman, Cynthia Magro. Medical College of Wisconsin, Milwaukee, WI; Mayo Clinic, Rochester, MN; Weill Medical College of Cornell University, New York, NY
Background: Lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (PALCL) belong to the group of CD30+ lymphoproliferative disorders. LyP is a self-healing disorder with “waxing and waning” papules and nodules. The disease is characterized by a favorable prognosis; however, secondary lymphomas like mycosis fungoides or Hodgkin disease may develop. PCALCL represents one end of the spectrum of CD30 (+) lymphoproliferative disorders and it has been generally regarded as clinically indolent lymphoma. There is limited precedent literature regarding cytotoxic profile in cutaneous CD30+ lymphoproliferative disorders and there are only rare cases reported in the literature. The purpose of this study is to highlighty the clinical, light microscopic,and phenotypic features of CD8+ cutaneous CD30 lymphoproliferative disorders emphasizing the differential diagnostic distinction from more agrresive T-cell lymphomas.
Design: The diagnoses of CD30+ lymphoproliferative disorders were based on standard published histopathologic criteria and results of immunohistochemical studies at the time of initial diagnosis. We describe 18 cases (14 males, 17-77 years old; 4 females, 10-61 years old) of CD30+ lymphoproliferative lesions expressing CD8 / CD30 immunophenotype. 14 cases were compatible with PCALCL and 4 cases with LyP.
Results: All of our cases showed co-expression of CD30 and CD8. Follow-up data available in all patients revealed that two cases had associated systemic disease involvement and two cases had associated mycosis fungoides and chronic lymphocytic leukemia. Histologically, one case of ALCL showed prominent myxoid changes, one case of ALCL had extensive intravascular involvement, and one case of LyP was clasified as type D.
Conclusions: There is limited precedent literature regarding cutaneous CD30+ lymphoproliferative disorders with CD8 coexpression. Most cytotoxic T-cell lymphomas demonstrate an aggressive clinical course and there is a low threshold to initiate cytotoxic therapy in this setting. In cases of cutaneous CD8/CD30 co-expression this should prompt a careful clinical history for associated systemic disease and previous self-resolving lesions. Also, this cytotoxic profile may create diagnostic pitfalls as may be histopathologically indistinguishable from more aggressive lymphomas such as primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 122, Tuesday Morning