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Cutaneous Pseudolymphomas at a Glance
  • A diverse group of skin disorders characterized by dense lymphoid infiltrates mimicking various types of cutaneous lymphomas.
  • Two major immunologic categories: (1) mixed B and T cell (cutaneous lymphoid hyperplasia, Kimura disease, angiolymphoid hyperplasia with eosinophilia, Castleman disease) and (2) T cell (pseudomycosis fungoides, lymphomatoid contact dermatitis, Jessner's lymphocytic infiltration of the skin).
  • Most are idiopathic but some are reactions to foreign antigens introduced locally or systemically.
  • Usually present as violaceous, solitary, or localized papules, plaques, or nodules.
  • Some cases harbor occult dominant lymphoid clones; occasional cases progress to overt cutaneous lymphomas.

Cutaneous pseudolymphoma is a term used to describe skin lesions that bear a clinical and/or histopathologic resemblance to lymphoma. Over the years, a wide variety of designations have been included in this category. Some of these represent outdated synonyms, some refer to variants of the same entity, and some are misnomers for diseases now recognized to be true lymphomas. The relevant entities that are discussed in this and other chapters can be organized into several distinct disorders based on their lymphoid subset composition, pattern of cutaneous infiltration, and associated clinical findings (Table 146-1).

Table 146-1 Classification of Cutaneous Pseudolymphomas

Epidemiology

Cutaneous lymphoid hyperplasia (CLH) has a worldwide distribution and affects all races and ethnic groups. It occurs in both adults and children. Females are more commonly affected than males.

Etiology and Pathogenesis

CLH is characterized by a relatively dense lymphoid infiltrate, centered in the reticular dermis, which is usually B-cell rich and may resemble lymphoma clinically and/or histopathologically. Many terms are used to refer to this type of pseudolymphoma, including Spiegler–Fendt sarcoid, lymphocytoma cutis, lymphadenosis benigna cutis, and cutaneous lymphoplasia. Cutaneous lymphoid hyperplasia is the preferred term because it accurately describes the underlying pathophysiology of the lesion and is unlikely to be confused with terms used to describe various forms of cutaneous lymphoma.16

In most cases, CLH is idiopathic; however, some lesions are associated with exposure to foreign antigens from arthropods (bites, stings, infestations), infections (herpes zoster, Borrelia burgdorferi, Helicobacter pylori), tattoos, acupuncture, trauma, gold jewelry, vaccinations, hyposensitization injections, or medications (Figs. 146-1, ...

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