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. 2004 Jul 1;122(4):161-5.
doi: 10.1590/s1516-31802004000400006. Epub 2004 Nov 9.

Reassessment of diagnostic criteria in cutaneous lymphocytic infiltrates

Ana Cristina Cotta  1 , Maria Letícia Cintra, Elemir Macedo de Souza, Luis Alberto Magna, José Vassallo
Affiliations

Reassessment of diagnostic criteria in cutaneous lymphocytic infiltrates

Ana Cristina Cotta et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context: Non-specific lymphocytic infiltrates of the skin pose difficulties in daily practice in pathology. There is still a lack of pathognomonic signs for the differential diagnosis between benign and malignant lymphocytic infiltrates.

Objective: To evaluate the morphological and immunohistochemical profile of lymphocytic infiltrations of the skin according to clinical outcome.

Type of study: Retrospective; histopathological and immunohistochemical analysis.

Setting: Referral center, university hospital.

Sample: 28 cases of lymphocytic infiltrates of difficult differential diagnosis selected from the records.

Main measurements: Eighteen histological variables and the immunophenotypic profile were assessed using the CD4, CD8, CD3, CD20 and CD30 lymphoid markers and compared to subsequent follow-up.

Results: The most common diagnoses were: initial mycosis fungoides (eight cases) and drug reactions (five cases). Single morphological variables did not discriminate between benign and malignant infiltrates except for the presence of Pautrier-Darier's microabscesses, which were found only in mycosis fungoides (p = 0.015). Patterns of superficial and deep infiltration (p = 0.037) and also the presence of eosinophils (p = 0.0207) were more frequently found in benign lymphocytic infiltrates. Immunohistochemical profile of T-cell subsets showed overlap between benign and malignant infiltrates with a predominance of CD4-positive (helper) lymphocytes in the majority of cases.

Conclusions: A combination of clinical and histological features remains the most reliable approach for establishing a definite diagnosis in cases of lymphoid skin infiltrates.

CONTEXTO:: Infiltrações linfocitárias não-específicas da pele representam dificuldades diagnósticas na prática diária da patologia. Não há sinais patognomônicos para o diagnóstico diferencial entre infiltrações linfocitárias benignas e malignas.

OBJETIVOS:: Avaliar o perfil morfológico e imunofenotípico das infiltrações linfocitárias de acordo com a evolução clínica.

TIPO DE ESTUDO:: Retrospectivo: análise histopatológica e imunoistoquímica.

LOCAL:: Centro de referência, hospital universitário.

AMOSTRA:: 28 casos de infiltrações linfocitárias de diagnóstico diferencial difícil selecionados dos arquivos.

PRINCIPAIS MEDIDAS:: Análise de 18 variáveis histológicas e perfil imunofenotípico utilizando os marcadores linfóides CD4, CD8, CD3, CD20 e CD30, comparados à evolução clínica.

RESULTADOS:: Os diagnósticos mais comuns foram: micose fungóide — inicial (oito casos) e farmacodermias (cinco casos). Variáveis morfológicas isoladas não discriminaram infiltrados benignos e malignos, exceto pela presença dos microabscessos de PautrierDarier, que foram encontrados apenas na micose fungóide (p = 0,015). O padrão de infiltração superficial e profunda (p = 0,037) e a presença de eosinófilos (p = 0,0207) foram mais freqüentes nas infiltrações linfocitárias benignas. O perfil imunoistoquímico dos linfócitos T mostrou sobreposição entre infiltrações benignas e malignas, com predomínio de linfócitos T auxiliares CD4 positivos na maioria dos casos.

CONCLUSÃO:: A combinação das informações clínicas e histológicas representa a abordagem mais consistente para o diagnóstico diferencial dos infiltrados linfóides cutâneos.

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Figures

Figure 1
Figure 1. Mycosis fungoides: compact orthokeratosis, Pautrier-Darier's microabscess, moderate spongiosis (hematoxylin-eosin; 200 x).
Figure 2
Figure 2. Benign lymphocytic infiltration of the skin: CD4-positive lymphoid cells (immunoperoxidase; 200 x).
Figure 3
Figure 3. Mycosis fungoides: CD8-positive infiltrating lymphocytes (immunoperoxidase; 200 x).
See this image and copyright information in PMC

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References

    1. Elder D, Elenitsas R, Jawarsky C, Johnson B. Lever's Histopathology of the Skin. 8 edition. Philadelphia: Lippincott-Raven; 1997.
    1. Weedon D. Skin Pathology. London: Churchill Livingstone; 1997.
    1. Ming M, LeBoit PE. Can dermatopathologists reliably make the diagnosis of mycosis fungoides? If not, who can? Arch Dermatol. 2000;136(4):543–546. - PubMed
    1. Santucci M, Biggeri A, Feller AC, Massi D, Burg G. Efficacy of histologic criteria for diagnosing early mycosis fungoides: an EORTC cutaneous lymphoma study group investigation. European Organization for Research and Treatment of Cancer. Am J Surg Pathol. 2000;24(1):40–50. - PubMed
    1. Ackerman AB. Histologic Diagnosis of Inflammatory Skin Diseases. 2 edition. Baltimore: Williams & Wilkins; 1997.

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