Histopathological aspects and differential diagnosis of CD8 positive lymphomatoid papulosis

J Cutan Pathol. 2016 Nov;43(11):963-973. doi: 10.1111/cup.12779. Epub 2016 Aug 30.

Abstract

Lymphomatoid papulosis (LyP) belongs to CD30+ lymphoproliferative disorders with indolent clinical course. Classic histological subtypes, A, B and C are characterized by the CD4+ phenotype, while CD8+ variants, most commonly classified as type D, were reported in recent years. We present 14 cases of CD8+ LyP. In all patients, self-resolving or treatment-sensitive papules were observed. Of 14 cases 7 produced results with typical microscopic features of LyP type D mimicking primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma. The infiltration pattern in 4 of 14 cases were consistent with classic LyP type B, without CD30 expression in two cases, resembling mycosis fungoides (MF). The morphology of 2 of 14 cases shared a certain consistency with classic type A and C, lacking eosinophils and neutrophils. Extensive folliculotropism characteristic to type F was observed in 1 of 14 case. Significant MUM1 and PD1 expression were detected in 2 of 14 and 3 of 14 cases, respectively. We concluded that CD8+ LyP may present with different histopathological features compared with type D, similar to CD4+ LyP variants. Differential diagnoses include CD8+ papular MF, folliculotropic MF and anaplastic large cell lymphoma in addition to primary cutaneous aggressive epidermotropic T-cell lymphoma. We emphasise that rare CD8+ LyP cases may exist with CD30-negativity.

Keywords: CD30 antigen expression; CD8 positive cutaneous T-cell lymphoma; CD8 positive lymphomatoid papulosis type A,B,C,D,F; cutaneous CD30+ lymphoproliferative disorders; lymphomatoid papulosis.

MeSH terms

  • Adult
  • Aged
  • CD8 Antigens / metabolism*
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Interferon Regulatory Factors / metabolism
  • Lymphomatoid Papulosis / immunology
  • Lymphomatoid Papulosis / pathology*
  • Male
  • Middle Aged
  • Programmed Cell Death 1 Receptor / metabolism
  • Skin Neoplasms / immunology
  • Skin Neoplasms / pathology*

Substances

  • CD8 Antigens
  • Interferon Regulatory Factors
  • PDCD1 protein, human
  • Programmed Cell Death 1 Receptor
  • interferon regulatory factor-4