Indolent cutaneous CD8+ lymphoid proliferation pathology

Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand. January 2015.


Indolent cutaneous CD8+ lymphoid proliferation is a recently described rare entity among cutaneous T-cell lymphomas that typically presents with solitary skin lesions on the face or at acral sites.

Histology of indolent cutaneous CD8+ lymphoid proliferation

Histologically, indolent CD8+ lymphoid proliferations are characterised by a dense dermal infiltrate of non-epidermotropic, medium sized pleomorphic lymphocytes. These form a dense mass in the dermis and may involve subcutaneous tissues (figures 1-5).

Indolent cutaneous CD8+ lymphoid proliferation pathology

Special studies for indolent cutaneous CD8+ lymphoid proliferation

The T-cells stain with CD3 and CD8 (figure 6). There is minimal staining with CD4. Other T cell markers are variable expressed. CD68 is positive in most cases.

T-Cell receptor gene rearrangement may be demonstrated with rearrangement studies.

Differential diagnosis of indolent cutaneous CD8+ lymphoid proliferation

Aggressive cutaneous CD8 positive lymphoma – These do not usually present as single tumours/plaques. CD68 is typically negative and is thought to be a helpful distinguishing feature.

Mycosis fungoides – Clinical presentation is key in distinguishing this entity from tumour stage mycosis fungoides. If the patient has a past history of mycosis fungoides, caution should be take in diagnosing cutaneous small-medium pleomorphic T-Cell lymphoma.

T-cell pseudolymphoma – May be similar and many cases may have been called pseudolymphoma in the past. Immunohistochemical studies and T-Cell gene rearrangement studies may be helpful to illustrate a clonal population.

Cutaneous small–medium pleomorphic T-Cell lymphoma – This entity is composed predominantly of CD4 positive cells. Some authors question whether this is a related entity (given similar benign presentation and course).

Contribute to Dermnet

Did you find this page useful? We want to continue to deliver accurate dermatological information to health professionals and their patients — for free. Funding goes towards creating articles for DermNet, supporting researchers, and improving dermatological knowledge around the world.

Donate now with credit card or Paypal

 

Related information