CD30-positive cutaneous lymphoma: report of four cases with an emphasis on clinicopathological correlations*

The classification of cutaneous lymphomas is multidisciplinary and requires the correlation between clinical, histopathological, immunohistochemical, and molecular diagnostic elements. In this article, we present four different cases of CD30-positive T-cell lymphoma with cutaneous manifestations. We compare cases with definitive diagnosis of papulosis lymphomatoid type C, primary cutaneous anaplastic large T-cell lymphoma, systemic anaplastic large T-cell lymphoma with secondary skin involvement, and mycosis fungoides with large cell transformation, highlighting the importance of clinicopathological correlation to classify these cases.

Keywords:
Anaplastic large cell lymphoma; Cutaneous T-cell lymphoma; Lymphomatoid papulosis; Lymphoproliferative disorders; Mycosis fungoides; Primary cutaneous anaplastic large cell lymphoma

Authorship

Thiago Jeunon de Sousa Vargas

Hospital Federal de Bonsucesso - Bonsucesso (RJ), BrazilHospital Federal de BonsucessoBrazilBonsucesso, RJ, BrazilHospital Federal de Bonsucesso - Bonsucesso (RJ), Brazil

Samira Barroso Jorge Mailing address: Samira Barroso Jorge, Av. Londres, 616 - Prédio 6, Bonsucesso, 21041-030 Rio de Janeiro, RJ - Brazil. E-mail: samirabarroso@yahoo.com.br

Hospital Federal de Bonsucesso - Bonsucesso (RJ), BrazilHospital Federal de BonsucessoBrazilBonsucesso, RJ, BrazilHospital Federal de Bonsucesso - Bonsucesso (RJ), Brazil

Yung Bruno de Mello Gonzaga

Hospital Federal de Bonsucesso - Bonsucesso (RJ), BrazilHospital Federal de BonsucessoBrazilBonsucesso, RJ, BrazilHospital Federal de Bonsucesso - Bonsucesso (RJ), Brazil

Instituto Nacional de Câncer (INCA) - Rio de Janeiro (RJ), BrazilInstituto Nacional de CâncerBrazilRio de Janeiro, RJ, BrazilInstituto Nacional de Câncer (INCA) - Rio de Janeiro (RJ), Brazil

Mailing address: Samira Barroso Jorge, Av. Londres, 616 - Prédio 6, Bonsucesso, 21041-030 Rio de Janeiro, RJ - Brazil. E-mail: samirabarroso@yahoo.com.br

Conflict of Interest: None

SCIMAGO INSTITUTIONS RANKINGS

Hospital Federal de Bonsucesso - Bonsucesso (RJ), BrazilHospital Federal de BonsucessoBrazilBonsucesso, RJ, BrazilHospital Federal de Bonsucesso - Bonsucesso (RJ), Brazil

Instituto Nacional de Câncer (INCA) - Rio de Janeiro (RJ), BrazilInstituto Nacional de CâncerBrazilRio de Janeiro, RJ, BrazilInstituto Nacional de Câncer (INCA) - Rio de Janeiro (RJ), Brazil

Figures

Figures (8)

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Figure 1
Lymphomatoid papulosis. A) Multiple erythematous papules, some with small erosions covered by scales and crusts and scarring lesions distributed symmetrically. B) Details of the lesions in three distinct evolutionary stages: the marking indicates a fully developed lesion (ideal for biopsy); under it, there is an ulcerated papule in involution; above, there is a completely regressed lesion

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Figure 2
Lymphomatoid papulosis type C. A) Dermis showing a V-shaped cell infiltrate associated with blurring of the dermal-epidermal junction, rectification of epidermal cones, and hyperkeratosis (Hematoxylin & eosin x40). B) Dense cellular infiltrate on the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm. Some binucleate lymphocytes resembling Reed-Sternberg cells are present (Hematoxylin & eosin x400)

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Figure 3
Primary cutaneous anaplastic large cell lymphoma. Nodular and tumor lesions with ulcerated surface present on the right foot, leg, and arm

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Figure 4
Primary cutaneous anaplastic large cell lymphoma. Dense diffuse infiltrate in the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm. Mitotic figures are easily visualized (Hematoxylin & eosin x400). Inset: diffuse positivity of neoplastic lymphocytes in immunohistochemical reaction with anti-CD30 primary antibody (Hematoxylin & eosin x400)

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Figure 5
Systemic anaplastic large T-cell lymphoma. Ulcerated nodule on the left scapular region

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Figure 6
Systemic anaplastic large T-cell lymphoma. Dense diffuse infiltrate in the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm (Hematoxylin & eosin x400). Inset: diffuse positivity of neoplastic lymphocytes in immunohistochemical reaction with anti-ALK primary antibody (Hematoxylin & eosin x400)

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Figure 7
Large-cell transformation of mycosis fungoides. Plaque in polycyclic configuration with eroded surface. Ulceration covered by a blackened crust in the central portion. Note that the skin around the plaque reveals discreet erythema and fine scales that extended throughout the body

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Figure 8
Large-cell transformation of mycosis fungoides. A) Dermis showing band-like infiltration in the papillary portion and around the skin appendages in depth (Hematoxylin & eosin x20). B) Dermis showing lymphocytes with large pleomorphic vesicular nuclei and abundant cytoplasm, interspersed with small lymphocytes and eosinophils (Hematoxylin & eosin x400)

Figure 1 Lymphomatoid papulosis. A) Multiple erythematous papules, some with small erosions covered by scales and crusts and scarring lesions distributed symmetrically. B) Details of the lesions in three distinct evolutionary stages: the marking indicates a fully developed lesion (ideal for biopsy); under it, there is an ulcerated papule in involution; above, there is a completely regressed lesion

Figure 2 Lymphomatoid papulosis type C. A) Dermis showing a V-shaped cell infiltrate associated with blurring of the dermal-epidermal junction, rectification of epidermal cones, and hyperkeratosis (Hematoxylin & eosin x40). B) Dense cellular infiltrate on the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm. Some binucleate lymphocytes resembling Reed-Sternberg cells are present (Hematoxylin & eosin x400)

Figure 3 Primary cutaneous anaplastic large cell lymphoma. Nodular and tumor lesions with ulcerated surface present on the right foot, leg, and arm

Figure 4 Primary cutaneous anaplastic large cell lymphoma. Dense diffuse infiltrate in the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm. Mitotic figures are easily visualized (Hematoxylin & eosin x400). Inset: diffuse positivity of neoplastic lymphocytes in immunohistochemical reaction with anti-CD30 primary antibody (Hematoxylin & eosin x400)

Figure 5 Systemic anaplastic large T-cell lymphoma. Ulcerated nodule on the left scapular region

Figure 6 Systemic anaplastic large T-cell lymphoma. Dense diffuse infiltrate in the dermis, consisting of lymphocytes with large pleomorphic vesicular nuclei and conspicuous cytoplasm (Hematoxylin & eosin x400). Inset: diffuse positivity of neoplastic lymphocytes in immunohistochemical reaction with anti-ALK primary antibody (Hematoxylin & eosin x400)

Figure 7 Large-cell transformation of mycosis fungoides. Plaque in polycyclic configuration with eroded surface. Ulceration covered by a blackened crust in the central portion. Note that the skin around the plaque reveals discreet erythema and fine scales that extended throughout the body

Figure 8 Large-cell transformation of mycosis fungoides. A) Dermis showing band-like infiltration in the papillary portion and around the skin appendages in depth (Hematoxylin & eosin x20). B) Dermis showing lymphocytes with large pleomorphic vesicular nuclei and abundant cytoplasm, interspersed with small lymphocytes and eosinophils (Hematoxylin & eosin x400)

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