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Eruption of lymphocyte recovery with atypical lymphocytes mimicking a primary cutaneous T-cell lymphoma: a series of 12 patients.
Journal article

Eruption of lymphocyte recovery with atypical lymphocytes mimicking a primary cutaneous T-cell lymphoma: a series of 12 patients.

  • Hurabielle C Department of Dermatology, Hôpital Henri-Mondor, AP-HP, 94220 Créteil, France.
  • Sbidian E Department of Dermatology, Hôpital Henri-Mondor, AP-HP, 94220 Créteil, France.
  • Beltraminelli H Department of Dermatology, Inselspital Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
  • Bouchindhomme B Department of Pathology, Lille University Hospital, 59000 Lille, France.
  • Chassagne-Clément C Department of Pathology, Centre Léon Bérard, 69008 Lyon, France.
  • Balme B Department of Pathology, Lyon-Sud University Hospital, 69310 Pierre-Bénite, France.
  • Bossard C Department of Pathology, Nantes University Hospital, 44093 Nantes Cedex 1, France.
  • Delfau-Larue MH Department of Biological Hematology and INSERM U955 team 9, AP-HP, Henri-Mondor Hospital, 94220 Créteil, France.
  • Wolkenstein P Department of Dermatology, Hôpital Henri-Mondor, AP-HP, 94220 Créteil, France.
  • Chosidow O Department of Dermatology, Hôpital Henri-Mondor, AP-HP, 94220 Créteil, France.
  • Cordonnier C Department of Hematology, AP-HP, Henri-Mondor Hospital, 94220 Créteil, France.
  • Toma A Department of Hematology, AP-HP, Henri-Mondor Hospital, 94220 Créteil, France.
  • Pautas C Department of Hematology, AP-HP, Henri-Mondor Hospital, 94220 Créteil, France.
  • Ortonne N Department of Pathology and INSERM U955 team 9, AP-HP, Henri-Mondor Hospital, 94220 Créteil, France. Electronic address: nicolas.ortonne@aphp.fr.
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  • 2017-11-07
Published in:
  • Human pathology. - 2018
CD30+ lymphoproliferative disorder
Cutaneous T-cell lymphoma
Eruption of lymphocyte recovery
Maculopapular rash
Pseudolymphoma
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Diagnosis, Differential
Drug Eruptions
Female
Humans
Lymphocyte Activation
Lymphoma, T-Cell, Cutaneous
Male
Middle Aged
Skin Neoplasms
T-Lymphocytes
English Eruption of lymphocyte recovery (ELR) may occur during bone marrow aplasia after chemotherapies. We reviewed the clinical and pathologic features of 12 patients (male-female ratio, 7:5; median age, 61 years) with an atypical ELR histologically mimicking a primary cutaneous T-cell lymphoma such as Sézary syndrome or CD30+ T-cell lymphoproliferative disorder. All the patients displayed an erythematous maculopapular eruption on the trunk and the limbs associated with fever. All but one had received a polychemotherapy for an acute myeloid leukemia (n=10) or a urothelial carcinoma (n=1) before the occurrence of the skin eruption. One had an autoimmune lymphoproliferative syndrome causing chronic agranulocytosis requiring granulocyte colony-stimulating factor injection. In all patients, the skin eruption was associated with a slight increase of white blood cell count followed by bone marrow recovery within the next weeks. All skin biopsies showed a dermal perivascular lymphocytic infiltrate containing atypical medium- to large-sized CD3+, CD4+ and CD8+, CD25+, ICOS+, PD1- lymphocytes with a strong CD30 expression in most instances (n=10), suggesting the recruitment of strongly activated T cells in the skin. In 6 patients, a diagnosis of CD30+ lymphoproliferative disorder or Sézary syndrome was proposed or suspected histopathologically, and only the clinical context allowed the diagnosis of ELR with a peculiar presentation with atypical lymphocytes. We describe a series of patients with an unusual form of ELR characterized by the presence of atypical activated T cells in the skin. On a practical ground, pathologists should be aware of this distinctive and misleading presentation.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/178037
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