Pseudocarcinomatous Hyperplasia Hiding Lymphomatoid Papulosis: A "Low-Power View" Pitfall

Pseudocarcinomatous hyperplasia (PCH) is a reactive proliferation of the epidermis that can be associated with many inflammatory and neoplastic conditions. Histologically, it is characterized by irregular strands of epidermis, usually at the level of the follicular infundibulum, projecting downward...

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Published inInternational journal of surgical pathology Vol. 24; no. 3; p. 232
Main Authors Bellafiore, Salvatore, Grenzi, Laura, Simonetti, Vito, Piana, Simonetta
Format Journal Article
LanguageEnglish
Published United States 01.05.2016
Subjects
Humans
Hyperplasia - etiology
Hyperplasia - pathology
Lymphomatoid Papulosis - complications
Lymphomatoid Papulosis - pathology
Male
Middle Aged
Skin - pathology
Skin Diseases - etiology
Skin Diseases - pathology
Skin Neoplasms - complications
Skin Neoplasms - pathology
lymphomatoid papulosis
pseudocarcinomatous hyperplasia
CD30 positive
pitfall
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Summary:Pseudocarcinomatous hyperplasia (PCH) is a reactive proliferation of the epidermis that can be associated with many inflammatory and neoplastic conditions. Histologically, it is characterized by irregular strands of epidermis, usually at the level of the follicular infundibulum, projecting downward into the dermis. The differentiation between a well-differentiated squamous cell carcinoma and PCH can be particularly challenging when the biopsy is superficial and the causing lesion is dermal-based. Lymphomatoid papulosis (LyP) is an uncommon, self-healing, recurrent, cutaneous T-cell lymphoma, included among the primary cutaneous CD30-positive T-cell lymphoproliferative disorders. LyP is characterized by a chronic course of years to decades that does not compromise survival, even if patients with LyP are at risk for second cutaneous or nodal lymphoid malignancies. LyP and other lymphomas are major neoplastic causes of PCH and can be misdiagnosed or completely overlooked if the PCH is particularly exuberant. We describe the case of an otherwise healthy 55-year-old man who presented with a 3-month history of erythematous papules on upper and lower limbs. A diagnosis of LyP associated with PCH was made after 3 skin biopsies. The propensity of the CD30+ cutaneous lymphoproliferative disorders to an incognito growth pattern is well recognized, and a low-magnification scanning of the histological slides can be an inappropriate approach.
ISSN:1940-2465
DOI:10.1177/1066896915623364