A Primary Cutaneous CD30-Positive T-Cell Lymphoproliferative Disorder Arising in a Patient With Multiple Myeloma and Cutaneous Amyloidosis

• Published in: The American journal of dermatopathology Vol. 38; no. 5; p. 388
• Main Authors: Romano, Ryan C, Cohen, Daniel N, Howard, Matthew T, Wieland, Carilyn N
• Format: Journal Article
• Language: English
• Published: United States 01.05.2016
• Subjects: Aged; Amyloidosis - diagnosis; Amyloidosis - immunology; Biomarkers, Tumor - analysis; Biopsy; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Ki-1 Antigen - analysis; Lymphocytes, Tumor-Infiltrating - immunology; Lymphocytes, Tumor-Infiltrating - pathology; Lymphomatoid Papulosis - immunology; Lymphomatoid Papulosis - pathology; Multiple Myeloma - diagnosis; Multiple Myeloma - immunology; Predictive Value of Tests; Skin Neoplasms - immunology; Skin Neoplasms - pathology; T-Lymphocytes - immunology; T-Lymphocytes - pathology
• ISSN: 1533-0311
• DOI: 10.1097/DAD.0000000000000534

CD30-positive cutaneous lymphoproliferative disorders, a group of T-cell neoplasms, including lymphomatoid papulosis (LyP) and cutaneous anaplastic large cell lymphoma, require careful clinicopathologic correlation for diagnosis. An association between LyP and the development of a second hematolymphoid malignancy has been established in the literature. LyP has also been reported with systemic amyloidosis, but no such reports have documented coexisting cutaneous amyloid deposition with LyP to our knowledge. A 66-year-old woman with cutaneous amyloidosis, secondary to multiple myeloma, in remission, presented with erythematous and dark-brown papules involving the right arm, scalp, and torso. Punch biopsy of the arm showed a dermal infiltrate of intermediate-sized lymphocytes, some of which displayed a plasmacytoid morphology and prominent nodular subepidermal amyloid deposition. Punch biopsy of the scalp similarly showed a nonepidermotropic dense dermal infiltrate of intermediate-sized plasmacytoid lymphocytes and multifocal amyloid deposition. Both infiltrates were immunophenotypically CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoproliferative processes. Subsequent studies showed no systemic involvement, and clinical correlation suggested a final diagnosis of LyP. We present this case of LyP, which histologically mimics a B-cell proliferation with a plasmacytoid morphology arising in association with cutaneous amyloidosis to highlight the importance of clinicopathologic correlation, a thorough battery of immunohistochemical studies, and consideration for a second hematologic malignancy arising in the setting of LyP.