Chapter 146 Inflammatory Diseases That Simulate Lymphomas: Cutaneous Pseudolymphomas

Question 1

Pathogenesis of cutaneous lymphoid hyperplasia?

Answer 1

Relatively dense lymphoid infiltrate
Centered in reticular dermis
B-cell rich

Question 2

CLH presents most commonly as a _____ _____, but it can also appear as a localized array of nodules, plaques or papules.
The head, neck, extremities, _____ and _____ are common sites

Answer 2

solitary nodule

breast, genitalia

Question 3

Histopathology of cutaneous lymphoid hyperplasia?

Answer 3

Dense nodular or diffuse LYMPHOID infiltrate concentrates in reticular dermis

Epidermis is normal separated from underlying infiltrate by narrow GRENZ ZONE of uninvolved papillary dermis

Question 4

Defining immunophenotypic feature of CLH?

Answer 4

Small nongerminal center B cells and plasma cells are polytypic (mixture of kappa and lambda positive cells)

Question 5

Diff Dx of CLH

Answer 5

Chronic cutaneous LE
Jessner’s lymphocytic infiltration of skin
Granuloma faciale

Question 6

First line Tx of CLH ?
Examples: Excision,
Mid to high potency Topical steroid

Answer 6

IL steroid 5-40mg/mL, 1 mL monthly
Antibiotics ( minocycline 50-100mg BID, cephalexin 500mg BID)
Topical tacrolimus

Question 7

Cutaneous lymphoid Hyperplasia:

_______ are more commonly affected than _____

Answer 7

Females

males

Question 8

In most cases, CLH is _____;
however, some lesions are associated with exposure to foreign antigens from arthropods (bites, stings, infestations) , infections (_____, Borrelia burgdorferi, Helicobacter pylori), tattoos, acupuncture, trauma, ______, vaccinations, hyposensitization injections,

Answer 8

idiopathic
herpes zoster,
gold jewelry

Question 9

Medications that may induce CLH include phenytoin, carbamazepine, phenobarbital, _______, calcium channel blockers, angiotensin-converting enzyme inhibitors, _______, d-penicillamine, penicillin, mexiletine chloride, cyclosporine, and agents that inhibit binding of ____________________ receptors

Answer 9

β blockers
allopurinol,
histamine to H1, H2, or H1c

Question 10

CLH:
It should also include a review of systems focusing on so-called __________, such as fever of unknown origin, unexplained weight loss, night sweats, fatigue, and malaise.

Answer 10

lymphoma B symptoms

Question 11

CLH:
A general physical examination is important, with special attention to the type and distribution of skin lesions and to the status of peripheral ______, ______, ______.

Answer 11

lymph nodes, liver, and spleen

Question 12

CLH:

The use of topical and systemic glucocorticoids should be discontinued approximately _______ before biopsy if possible,

Answer 12

4 weeks

*because these agents can attenuate lymphoid infiltrates and thereby confound their interpretation

Question 13

CLH:
Hydantoin-associated pseudolymphoma syndrome is caused by anticonvulsant drugs such as _____.
This syndrome is characterized by fever, lymphadenopathy, ______, arthralgia, eosinophilia, and ________ cutaneous macules and papules or, rarely, nodules

Answer 13

phenytoin
hepatosplenomegaly,
generalized

Question 14

CLH:
__________________________________ presents as a unilateral eruption of angiomatous papules on the extremities.
There is a dense lymphoid infiltrate associated with histiocytes, plasma cells, and prominent, thickened capillaries.

Answer 14

Acral pseudolymphomatous angiokeratoma of children

Question 15

Kimura & AHLE:

Kimura disease is more common in Asian ____, whereas AHLE is more common in ____

Answer 15

men

women

Question 16

Kimura & AHLE:
Kimura disease represents a ___________________ form of the same basic pathogenetic process that gives rise to classic dermal ____

Answer 16

florid, subcutaneously deep-seated

CLH

Question 17

Kimura & AHLE:
AHLE lesions tend to be smaller and more superficial (centered in the ______________) and exhibit a more prominent __________,

Answer 17

dermis rather than the subcutis

vascular hyperplasia

Question 18

Kimura & AHLE:
Kimura disease presents as ______________ up to 10 cm in diameter centered in the ______, most commonly involving the head and neck.
Peripheral eosinophilia and regional ________ are characteristic.

Answer 18

solitary or multiple nodules
subcutis
lymphadenopathy

Question 19

Kimura & AHLE:

AHLE tends to present with multiple _____________________ that are typically unilateral

Answer 19

smaller, more superficial intradermal papulonodules

Question 20

Kimura & AHLE:

Histopathologically, the dermis and/or subcutis exhibit hyperplasia of __________ lined by plump ________

Answer 20

small blood vessels

endothelial cells

Question 21

Kimura & AHLE:
Histo
In general, lesions are more superficial and the vascular features are more prominent in _____, whereas lesions are deeper and the lymphoid features are more prominent in ______

Answer 21

AHLE

Kimura disease

Question 22

Kimura & AHLE:
Differentials?
Kimura - CBCL, _____, _______ and subcutaneous deposits of metastatic carcinoma
AHLE - CLH, CBCL,______, _____, ______, nodular Kaposi sarcoma, bacillary angiomatosis, and bartonellosis

Answer 22

sinus histiocytosis with massive lymphadenopathy, soft tissue tumors,

hemangioma, angiosarcoma, pyogenic granuloma

Question 23

Kimura & AHLE:

Kimura disease has been associated with ________ and renal disorders such as _________

Answer 23

lichen amyloidosis

nephrotic syndrome

Question 24

Kimura & AHLE:
___________ are used mainly for AHLE. ______________ has been reported to be superior to surgery and corticosteroids for treatment of Kimura disease

Answer 24

Topical treatments

Local radiation therapy

Question 25

Castleman disease:
The ____________ variant is more common in younger patients, the _____ variant occurs among the immunosuppressed and the other variants tend to occur in older individuals

Answer 25

hyaline vascular

HHV-8