Spectrum of CD30+ lymphoid proliferations in the eyelid lymphomatoid papulosis, cutaneous anaplastic large cell lymphoma, and anaplastic large cell lymphoma

Abstract

Purpose: To report the clinicopathologic features of 3 patients with CD30(+) lymphoid proliferations of the eyelid.

Design: Retrospective case series.

Participants: Patients with cutaneous CD30(+) lymphoproliferative lesions of the eyelid.

Methods: Three patients with CD30(+) non-mycosis fungoides T-cell lymphoid infiltrates of the eyelid were identified. The histories, clinical findings, pathologic features including immunohistochemical staining, treatments, and outcomes were reviewed and compared.

Main outcome measures: Pathologic findings including immunohistochemical analysis.

Results: The patients included an 81-year-old man, an 18-year-old man, and a 42-year-old woman with CD30(+) lymphoid proliferations of the eyelid and adjacent soft tissue. The first patient had an isolated crateriform eyelid lesion that was classified as lymphomatoid papulosis (LyP). The second patient had an isolated multinodular lesion of the eyelid that was classified as cutaneous anaplastic large cell lymphoma (cALCL). The third patient presented with eyelid edema with an underlying mass and was found to have widely disseminated anaplastic large cell lymphoma (ALCL). Diagnoses were dependent on clinical findings.

Conclusions: The CD30(+) lymphoid proliferations represent a spectrum of conditions ranging from indolent LyP, to moderately aggressive cALCL, to highly aggressive ALCL. Interpretation of the pathologic findings in CD30(+) lymphoid proliferations is based in part on clinical findings.

Financial disclosure(s): The authors have no proprietary or commercial interest in any material discussed in this article.

Figure 1

Case 1. There is an ulcerated cutaneous lesion in the right upper eyelid.

Figure 2

Case 1. A. There is a cellular infiltrate and reactive vascular channels present in the dermis. B. The cellular infiltrate consists of large, atypical lymphocytes, eosinophils and neutrophils. Immunohistochemical stains are positive for C. CD3 and D. CD30 in the atypical lymphocytes. (hematoxylin and eosin, A 25X, B 100X, peroxidase anti-peroxidase C and D, 100X)

Figure 3

Case 2. There is a multinodular, erythematous lesion with an overlying eschar in the right upped eyelid.

Figure 4

A. Case 2. A. There is a nodular proliferation of cells within the eyelids. B. These large cells exhibit round to oval, vesiculated nuclei, prominent nucleoli, and are interspersed with lymphocytes and eosinophils. Immunohistochemical stains are positive in the tumor cells for C. CD30, D. fascin, E. EMA and weakly for F. CLA. (hematoxylin and eosin, A 25X, B 100X, peroxidase anti-peroxidase C –F, 100X)

Figure 5

Case 3. There is marked edema of the left upper and lower eyelids.

Figure 6

Case 3. A. There are sheets of cells within the biopsy. B. These large cells exhibit pleomorphic, hyper chromatic nuclei. Immunohistochemical stains are positive in the tumor cells for C. CD30, D. ALK, E. EMA and F. CLA (staining small and large lymphocytes; negative in vascular channels). (hematoxylin and eosin, A 25X, B 100X, peroxidase anti-peroxidase C-F, 100X)

Figure 7

Case 3. FISH analysis shows the presence of the ALK fusion chromosome (yellow-green, arrow) for 5(2;5)(p;23.2;q23.5)

Figure 8

Case 3. An FDG-PET-CT shows hypermetabolic diffuse lymphadenopathy, omental and mesenteric implants, and deposits in skeletal muscle.