Ki-1-positive anaplastic large-cell lymphoma can mimic benign dermatoses.

Abstract

BACKGROUND:

Regressing atypical histiocytosis is a recently described disease characterized by recurrent nodules or ulcers. The cutaneous lesions appear abruptly and then regress only to return in a manner reminiscent of lymphomatoid papulosis. Immunophenotypic analysis has revealed that most cases are a form of anaplastic large-cell Ki-1-positive (CD30+) lymphoma.

OBJECTIVE:

We describe two patients with Ki-1-positive anaplastic large-cell lymphoma that had clinical and pathologic features of regressing atypical histiocytosis and mimicked benign dermatoses (pyoderma gangrenosum and morphea), causing a delay in confirming the true diagnosis. A third case that was readily recognized as a lymphoma is also presented.

METHODS:

The clinical and histopathologic findings were recorded. In addition, T-cell receptor gene rearrangement and immunophenotyping were determined in the index case.

RESULTS:

The index patient and second patient were diagnosed as having Ki-1-positive anaplastic large-cell lymphoma by immunophenotyping and underwent cyclophosphamide, doxorubicin, prednisone, and vincristine (CHOP) chemotherapy with complete remission. The patient detected by chart review died of her disease without receiving antineoplastic therapy; disseminated lymphoma was diagnosed at autopsy. Studies on paraffin-embedded tissue were consistent with Ki-1-positive anaplastic large-cell lymphoma.

CONCLUSION:

Regressing atypical histiocytosis may clinically resemble some benign dermatoses. Recent evaluation of these cases has shown that many represent a form of Ki-1-positive anaplastic large-cell lymphoma. Multiple skin biopsy specimens with immunophenotyping and gene rearrangement studies are required to arrive at the diagnosis.

• Authors: C Camisa, T N Helm, C Sexton, R Tuthill
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 29 Issue 5 Pt 1 Pg. 696-700 (Nov 1993) ISSN: 0190-9622 [Print] United States
• PMID: 8227541 (Publication Type: Case Reports, Journal Article)

Chemical References

• Ki-1 Antigen
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biopsy
• Cyclophosphamide (administration & dosage)
• Diagnosis, Differential
• Diagnostic Errors
• Doxorubicin (administration & dosage)
• Female
• Gene Expression
• Gene Rearrangement, T-Lymphocyte
• Humans
• Immunophenotyping
• Ki-1 Antigen (analysis)
• Lymphoma, Large-Cell, Anaplastic (diagnosis, drug therapy, immunology)
• Male
• Middle Aged
• Prednisone (administration & dosage)
• Pyoderma Gangrenosum (diagnosis)
• Scleroderma, Localized (diagnosis)
• Skin (pathology)
• Time Factors
• Vincristine (administration & dosage)