Lymphomatoid papulosis pathology

Author: Dr Ben Tallon, Dermatologist/Dermatopathologist, Tauranga, New Zealand, 2011.

Lymphomatoid papulosis is one of the two primary cutaneous CD30-positive cutaneous lymphomas, as classified by the WHO/EORTC.

Histology of lymphomatoid papulosis

Scanning power of the pathology of lymphomatoid papulosis reveals a wedge shaped inflammatory infiltrate extending to the deep dermis or superficial subcutaneous tissue (Figures 1 and 2). Note, it is made of prominent telangiectatic vessels and extravasation of erythrocytes in the case illustrated here (Figure 3 and 4). The lymphocytic population is comprised of a number of large CD30-positive lymphocytes (Figure 5). The mixture of cells forms a spectrum.

Type A: Scattered or grouped large CD30-positive lymphocytes (Figure 6) in a background of eosinophils and neutrophils.

Type B: A population of small lymphocytes may be seen with epidermotropism. This type may resemble mycosis fungoides.

Type C: Sheets of large anaplastic cells with only few admixed inflammatory cells resembling anaplastic large cell lymphoma.

Type D: Marked epidermotropism is seen histologically indistinguishable from primary cutaneous aggressive epidermotropic CD8+ cytotoxic T cell lymphoma

Special stains in lymphomatoid papulosis

A panel of immunoperoxidase markers is used, the key finding is CD30 positivity in Type A and C. Typically the tumour cells are CD4+, but CD8+ and CD56+ variants have been described. TIA-1, perforin and granzyme-B is expressed while ALK-1 is negative.

Fascin expression may indicate an increased risk for secondary malignancies.

Differential diagnosis of lymphomatoid papulosis

Primary cutaneous anaplastic large cell lymphoma: This tumour presents differentially clinically as typically a large solitary ulcerated tumour. Strictly by definition the >75% of the tumour cells must stain CD30 positive. A large nodular and cohesive population of large anaplastic cells is seen.

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