[Lymphomas and pseudolymphomas of the digestive tract. Retrospective study, with immunologic markers, of 52 malignant lymphomas and 5 pseudolymphomas].
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Adult↗
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[Unilateral exophthalmos revealing pseudolymphoma of the orbit. Pseudolymphoma of the orbit and Waldenström's disease].
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Exophthalmos↗
[Reactive lymph-node hyperplasia and pseudolymphomas with hypergammaglobulinemia. II. Pseudolymphoma and prelymphoma].
In this second part, the dysimmunitary conditions which associate a polyclonal hypergammapathy and adenopathy are studied. The latter simulate a malignant lymphoma both clinically and histologically, hence the term sometimes used: "pseudo-lymphoma". Above all, these dysimmunitary states should be considered as real pretumoral states, and a malignant lymphoma or Kaposi sarcoma can arise at any time during the evolution of the illness. Finally, all these illnesses, even apart from the appearance of malignant tumors, have a severe evolution and death can occur due to consequences of immune disorders and particularly to infection. The different histopathological and evolutive aspects of the following are successively studied: angio-immunoblastic lymphadenopathy; the association of adenopathy with Kaposi's sarcoma; the syndrome of epidemic immune deficiency of T cells (acquired immune deficiency syndrome; frequent in homosexuals; the Gougerot-Sjögren syndrome; adenopathy due to medicaments; and the lymphomatoid granulomatosis of Liebow. The similarity of the histopathological lymph node lesions observed in these different dysimmunitary states suggests an identical physiopathology. Also, the existence of frequent associations between these different diseases suggests a common triggering mechanism. The role of virus on a favourable hereditary ground is discussed.
Acquired Immunodeficiency Syndrome↗
Gastric "pseudolymphoma": a retrospective morphologic and immunophenotypic study of 97 cases.
BACKGROUND: The term "pseudolymphoma" has been used to describe lymphoid lesions that show: 1) borderline features between hyperplasia and neoplasia or 2) benign tumor-like enlargement of lymphoid tissue. The term pseudolymphoma has been applied to lesions in many anatomic locations, with the stomach being one of the more common sites. In spite of the frequent use of this term, neither the histologic criteria nor the clinical significance of this lesion have ever been clearly defined. Since the description of mucosa-associated lymphoid tissue (MALT) and its corresponding MALT-type lymphomas, the value of the term gastric pseudolymphoma has come into question. METHODS: The authors reviewed all cases diagnosed as gastric pseudolymphomas at the Armed Forces Institute of Pathology from 1970 to 1985. This period predated the description of low grade B-cell lymphoma of MALT-type. The cases were reclassified in light of current criteria and correlated with immunohistochemical findings and follow-up information. No patients were treated with chemotherapy or radiation therapy. RESULTS: Seventy-seven of 97 cases formerly diagnosed as pseudolymphoma were determined to be malignant lymphomas; the majority (51 cases) were extranodal marginal zone B-cell lymphomas (MALT-type). The remaining cases included reactive lymphoid hyperplasia associated with chronic follicular gastritis (15 cases) and atypical lymphoid infiltrates (5 cases). CONCLUSIONS: Most cases previously considered to be gastric pseudolymphomas are, by current criteria, malignant lymphomas. A small proportion are benign reactive lymphoid hyperplasias. Those cases of borderline or inconclusive nature are best diagnosed as atypical lymphoid infiltrates. The term gastric pseudolymphoma should be abandoned.
Adolescent↗
Cutaneous pseudolymphomas.
Cutaneous pseudolymphoma refers to a heterogeneous group of benign reactive T- or B-cell lymphoproliferative processes of diverse causes that simulate cutaneous lymphomas clinically and/or histologically. The inflammatory infiltrate is bandlike, nodular, or diffuse and is composed predominantly of lymphocytes with or without other inflammatory cells. Depending on the predominant cell type in the infiltrate, cutaneous pseudolymphomas are divided into T- and B-cell pseudolymphomas. Cutaneous T-cell pseudolymphomas include idiopathic cutaneous T-cell pseudolymphoma, lymphomatoid drug reactions, lymphomatoid contact dermatitis, persistent nodular arthropod-bite reactions, nodular scabies, actinic reticuloid, and lymphomatoid papulosis. Cutaneous B-cell pseudolymphomas include idiopathic lymphocytoma cutis, borrelial lymphocytoma cutis, tattoo-induced lymphocytoma cutis, post-zoster scar lymphocytoma cutis, and some persistent nodular arthropod-bite reactions. This review attempts to discuss current aspects of the classification, pathogenesis, clinical spectrum, histopathologic and immunohistochemical diagnosis, and laboratory investigations for clonality in the various types of cutaneous pseudolymphomas.
Diagnosis, Differential↗
Primary non-Hodgkin's lymphoma and pseudolymphoma of lung: a study of 161 patients.
The authors studied 161 cases of primary non-Hodgkin's lymphomas and pseudolymphomas of lung. Small lymphocytic proliferations, which they believe to be lymphomas, constituted 31.6 per cent of cases; plasmacytoid lymphocytic and small cleaved follicular center cell lymphomas (Lukes-Collins system), 22.4 and 11.8 per cent of cases, respectively; and the remaining follicular center cell lymphomas and B-immunoblastic sarcomas, 5.6 per cent of cases. Pseudolymphomas constituted 14 per cent of cases. Most patients were elderly and asymptomatic; in most cases a solitary nodule or infiltrate was observed on a chest radiograph. Radiographic evidence of effusion was found in both lymphomas and pseudolymphomas, but hilar adenopathy was restricted to lymphomas. A few peribronchial reactive germinal centers and intralesional giant cells/granulomas were seen frequently in unequivocal lymphomas, so their presence cannot be used to exclude neoplasia. A generally monomorphic cell population and invasion of bronchial cartilage or visceral pleura are suggestive of malignancy, whereas primitive cytologic appearance and invasion of lymph nodes or parietal pleura are pathognomonic of malignancy. Diffusely admixed mature lymphocytes and plasma cells with numerous reactive follicles suggest pseudolymphomas. Immunologic determination of clonality may be diagnostically definitive. Most localized lesions in lung were treated by surgical resection, whereas in cases of extensive pulmonary disease, biopsies were performed and patients were treated by chemotherapy or irradiation. Both lymphomas and pseudolymphomas recurred, most often within three years. Pseudolymphoma recurred only in lung. When distant spread of lymphoma occurred, it commonly involved extranodal sites. Only 18 of 101 patients with lymphoma died with or of tumor, and no patient with pseudolymphoma died of disease. Neither histologic subtype among the "small cell" lymphoid lymphomas nor the presence of regional node involvement was prognostically significant, but pleural effusion on the initial chest radiograph was a significant predictor of both recurrence and mortality.
Adolescent↗
Localized lymphoid nodules of lung. A reappraisal of the lymphoma versus pseudolymphoma dilemma.
Eleven patients with localized lymphoid nodules of the lung (LLN) were seen at the Mount Sinai Hospital from 1962-1981. The diagnosis of pseudolymphoma was made in six instances based on the following criteria: (1) solitary or multiple nodules discovered on chest roentgenograms composed of cytologically benign lymphoid cells (small lymphocytes); (2) polymorphic character of the infiltrate, including plasma cells, histiocytes and monocytes; and (3) presence of germinal centers in the lesion. Five lesions were classified as lymphomas and exhibited: (1) solitary or multiple nodules composed of atypical lymphoid cells; (2) absence of germinal centers; (3) lack of mediastinal lymph node involvement. Bronchial and/or pleural infiltration by lymphoid cells was present in lymphomas as well as in pseudolymphomas. Five lesions were studied with immunofluorescent techniques for the presence of intracytoplasmic immunoglobulins and in one pseudolymphoma, lymphocyte marker studies were performed. The procedures were not useful in separating benign from malignant lesions. All patients underwent surgery; three with lymphoma and one with pseudolymphoma received adjuvant chemotherapy. Patients were followed post surgically for up to 13 years. None of the six patients with pseudolymphoma died as a result of their lesions but two had either recurrences or developed extrapulmonary lymphoid lesions. All five lymphoma patients did well. Only one died while on chemotherapy with invasive pulmonary aspergillosis but no tumor. One-hundred and sixty-seven reported cases from the literature are analyzed. Pulmonary pseudolymphomas do not necessarily follow a benign course and malignant lymphomas limited to the lungs do not usually undergo progressive disease. Present pathologic criteria do not allow prediction of recurrence or progression of disease and are not acceptable for determining the advocacy of chemotherapy in patients with LLN.
Aged↗
Gastric pseudolymphoma. Not necessarily a benign lesion.
Gastric pseudolymphoma is thought to be a benign process. This report documents the malignant behavior of a gastric pseudolymphoma that was thought to be benign until a distant malignant B-cell lymphoma was demonstrated. Subsequent evaluation traced the B-cell lymphoma back to the gastric "pseudolymphoma." This finding stresses the relationship between gastric pseudolymphoma and gastric lymphoma, and the malignant potential of gastric pseudolymphoma. Multimodal tissue evaluation using histology, immunohistochemistry, and flow cytometry is essential. Surgical resection is the primary therapy for gastric pseudolymphoma.
Adult↗
[Clinical study of gastric lymphomas and pseudolymphomas (author's transl)].
The differentiation between gastric lymphomas and pseudolymphomas represents a clinical, surgical, and pathologic problem affecting both prognosis and therapy. Twenty patients were diagnosed for gastric lymphomas or gastric pseudolymphomas. Only those in stages IE or IIE were included in the first group (13 patients). Pseudolymphomas were diagnosed in seven patients on the basis of histopathologic criteria; all seven had peptic ulcers. Survival among the 13 patients diagnosed for lymphomas was low; six of them died within the first year. The seven cases diagnosed as pseudolymphoma progressed favorably over periods between 2 months and 5 years. The histologic parameters on which the differentiation of the two conditions was based included: a) cell type; b) distribution and limits of infiltration; c) presence of peptic ulcers in pseudolymphomas; and c) characteristics of the regional lymph nodes. The various possible mechanisms of pseudolymphomatous reaction are discussed. It is suggested that the relatively good prognosis reported in some series of gastric lymphomas may be due to the inclusion of pseudolymphomas. There is obvious justification for distinguishing between this two conditions.
Adult↗
[Pseudolymphoma of the breast involving the periareolar area].
Pseudolymphomas are a group of lymphoproliferative disorders which are difficult to classify and diagnose. They can affect several anatomical sites and, among these, a mammary localisation is considered rather rare. Pseudolymphomas of the breast carry an excellent prognosis, and no case of malignant degeneration has ever been described. On the contrary, cutaneous pseudolymphomas, which are considered very low-grade lymphomas by some authors, are actually able to progress to overt cutaneous lymphomas in a minority of cases. The authors present three cases of periareolar pseudolymphoma of the breast. The first two were characterised by the presence of an elevated serum antibody titer to Borrelia, and were therefore diagnosed as lymphocytoma cutis, a disorder affecting 0.6-1.3% of patients with Lyme's disease. Both cases had a benign clinical course, as confirmed by the negative follow-up after more than three years. On the contrary, the third pseudolymphoma, classifiable as an idiopathic form, relapsed locally after ten years, thus testifying to the benign nature of the lesion, but also demonstrating that the lymphoproliferative process may still be active after a long period of time. The last case emphasizes the need for long-term follow-up of these patients.
Adult↗
[Cutaneous pseudolymphoma caused by carbamazepine].
INTRODUCTION: Drug-induced cutaneous pseudolymphomas are poorly reported. They clinically and pathologically mimic malignant lymphomas but their evolution is benign after drug withdrawal. CASE REPORT: We herein reported a case of carbamazepine++-induced pseudolymphoma in a 30 year-old woman of particular interest because of the paucity of clinical symptoms (only six papules of less than one centimetre each). COMMENTS: Phenytoins, carbamazepine++, barbiturates and ACE inhibitors are the main drugs inducing cutaneous pseudolymphomas. These usually mimic T-cell lymphomas. The clinical spectrum of cutaneous pseudolymphomas is broad including severe aspects, such as erythroderma or tumoral eruption and benign appearing one as in our case. Drug investigation is mandatory for each patient with lymphoma appearing cutaneous infiltrates because dramatic and definitive healing of the lesion is always expected in case of pseudolymphoma.
Adult↗
Pseudolymphoma of the breast. I. In a study of 8,654 consecutive tylectomies and mastectomies.
Pseudolymphoma is a benign pathological process that morphologically resembles malignant lymphoma. Its occurrence in the mammary tissue has been described but has not been well investigated. We conducted a prospective and retrospective study of 8,654 consecutive mastectomies and tylectomies of the breast and found only 9 cases (0.1%) of primary lymphoreticular lesions. Of these 9, 5 were pseudolymphomas; 3, histiocytic lymphomas; and 1, Hodgkin's disease. Clinically, pseudolymphoma of the breast was described as an enlarging mass giving a dull, aching sensation. A history of physical trauma to the affected area could be traced in 3 patients with certainty. The mean patient age of the entire series was 36 years. Grossly, the tumor was a solid, firm nodule without any evidence of fibrocystic disease. Microscopically, it showed a lymphoid infiltrate with a nodular pattern. Three of the 5 cases revealed distinct germinal centers. Atypical lymphoid cells were not observed in any of these cases. After local excision, no patients had recurrence over a period of two to eight years. In view of a history of trauma, accompany fat necrosis in some cases, IgG gammopathy, it is postulated that pseudolymphoma of the breast, probably akin to pseudolymphoma of the lung, may represent an overwhelming local response to an injury. This lesion, reactive in nature, should be differentiated from a malignant lymphoma so that patients are not subjected to unnecessary mastectomy, radiation, or chemotherapy.
Adult↗
Evolution of B-cell lymphoma from pseudolymphoma. A multidisciplinary approach using histology, immunohistochemistry, and Southern blot analysis.
Cutaneous B-cell lymphomas are rare neoplasms that can present as lesions involving solely the skin or develop in association with a systemic lymphoma. Histologically they are often difficult to differentiate from pseudolymphomas, and the use of immunohistochemistry may be necessary to correctly classify them. We report a study of multiple skin lesions in a patient who initially presented with multiple pseudolymphomas, apparently associated with an immune response to the dye of his tattoos. Over a period of 4 years his skin lesions evolved from histologically benign and immunologically polyclonal pseudolymphomas to a histologically malignant and immunologically monoclonal B-cell large cell lymphoma. Genotypic analysis with a probe for the heavy-chain immunoglobulin gene demonstrated the presence of clonal B-cell populations in all of the pseudolymphoma biopsy samples as well as in the subsequent lymphoma tissue samples, with a pattern of clonal bands suggestive of evolution of the B-cell clones. These findings suggest that the development of B-cell lymphoma in this patient was related to a persistent abnormal immune response to the chronic antigenic stimulus of the dye of the tattoo. The presence of clonal B-cell populations in pseudolymphoma by Southern blot analysis may be useful in predicting those patients who will subsequently develop overt lymphoma.
Blotting, Southern↗
Cutaneous pseudolymphoma: an unusual presentation of a deep subcutaneous thigh mass.
Cutaneous pseudolymphoma is considered to be a benign (reactive) cutaneous lymphoid infiltrate; the term designates reactive diseases of the skin that histologically mimic cutaneous lymphoma. We report a case in which a 63-year-old female presented with a 5-month history of a progressive skin eruption and an enlarging subcutaneous mass following a presumed insect bite. Excisional biopsy showed this to be a pseudolymphoma extending from the dermis into the subcutaneous tissue. A number of pathological features that distinguish pseudolymphoma from cutaneous lymphoma, including histology, immunophenotype, and immunogenotype, are reviewed. The case herein challenges previous beliefs that pseudolymphoma is confined to cutaneous involvement and indicates that the process can involve deeper tissues. The final criterion for distinguishing benign from reactive processes is biological behavior. Since the depth of invasion in cutaneous pseudolymphoma has not previously been appreciated, the patient will need to be carefully examined periodically until the biological behavior of the process has been determined.
Female↗
Gastric pseudolymphoma. A challenging clinical problem.
Gastric pseudolymphoma is a benign inflammatory condition that is usually associated with chronic gastric ulcer and often mimics gastric carcinoma or malignant lymphoma. Our experience with 12 histologically documented gastric pseudolymphomas at the Medical College of Virginia is presented with an emphasis on the approach to both diagnosis and surgical management. Preoperative diagnoses in this series ranged from benign gastric ulcer to gastric cancer. Treatment was by gastric resection in all cases and it included, as a minimum, antrectomy and excision of the lesion with an adequate gross margin. Of 11 cases with adequate follow-up, there are eight asymptomatic patients without recurrence and one patient who died of other causes without recurrence 5 years after gastrectomy. One patient developed recurrent pseudolymphoma in the proximal gastric remnant 39 months after a distal subtotal gastrectomy for pseudolymphoma. Another patient subsequently developed Hodgkin's disease of the gastric remnant, with regional lymph node and liver involvement, and died 35 months after the earlier subtotal gastrectomy for pseudolymphoma. Our clinical experience with this confusing and uncommon entity is compared with that previously reported in the medical literature.
Adolescent↗
[Immunohistochemical classification of cutaneous lymphomas and pseudolymphomas].
We investigated 46 cases of cutaneous lymphoma and pseudolymphoma by immunohistochemical methods using a panel of monoclonal antibodies. Of the cutaneous T cell lymphomas, 2 did not show the classic helper phenotype but revealed a predominance of suppressor cells in one case and of immature thymocytes in the other. Cutaneous B cell lymphomas of low-grade malignancy were characterized by the presence of completely developed T zones between the B cell areas. B cell lymphomas of high-grade malignancy revealed an immunohistologically homogeneous infiltrate. Cutaneous pseudolymphomas can be classified in T cell pseudolymphomas (lymphocytic infiltration, lymphomatoid papulosis) and B cell pseudolymphomas. Lymphadenosis cutis benigna with germinal center cell differentiation was clearly distinguishable from other B cell pseudolymphomas, which are considered to comprise mainly peripheral B lymphocytes. Immunohistological methods are obviously useful in the classification of lymphoproliferative diseases of the skin and can make a contribution to increasing our understanding of them.
Antibodies, Monoclonal↗
Cutaneous pseudolymphoma due to topical application of 4% hydroquinone cream for melasma.
Cutaneous pseudolymphoma is an aggregate of mature or abnormal looking lymphocytes in the dermis, which clinically and /or histologically simulates lymphoma but has a benign course and outcome. Systemic drugs, especially anti-epileptics, are an important cause of cutaneous pseudolymphomas. Pseudolymphoma of the skin, secondary to topical drug application, is very rare. We report a case of cutaneous pseudolymphoma induced by local application of 4% hydroquinone cream to melasma over the cheeks.
Adult↗
Progression of cutaneous B-cell pseudolymphoma to cutaneous B-cell lymphoma.
BACKGROUND: Debates regarding nosology and clonality surround the entity known as cutaneous pseudolymphoma and its questionable transformation to frank cutaneous lymphoma. The relevance of these arguments is important, not only from a diagnostic standpoint, but also for making inferences based upon behavior, prognosis, and treatment. OBJECTIVE: Our goal was to demonstrate further evidence of progression from cutaneous pseudolymphoma to malignant lymphoma while at the same time advocating a comprehensive plan for evaluation, treatment, and followup of these patients. METHODS: A retrospective review was conducted of four patients initially considered to have cutaneous B-cell pseudolymphoma (CBPL) and who were later treated for primary cutaneous B-cell lymphoma (CBCL). A review of the literature of cases suggesting progression to malignant lymphoma from precursor lesions was also performed. RESULTS: Four patients initially diagnosed with CBPL by a combination of histologic, immunophenotypic, and gene rearrangement criteria had a progressive clinical course that, over a range of 17-51 months, evolved into CBCL. All patients had a comprehensive systemic workup to rule out the possibility of extracutaneous disease and were treated with local radiation therapy and close followup. There has been no evidence of extracutaneous disease with an average followup of 14 months. CONCLUSION: The potential for certain cutaneous pseudolymphomas to progress to CBCL is real. The combination of histologic and immunophenotypic criteria, along with the clinical picture, remains the best way to judge the aggressiveness of the lesion. Gene rearrangement studies, whether performed by Southern blot or polymerase chain reaction (PCR), are of limited value and should be used to support the overall clinicopathologic picture. Radiation therapy of these patients should be thought of early in the management plan and is a very successful form of treatment when combined with close followup.
Adult↗