CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement

Abstract

A 42‐year‐old Caucasian man suffered from disseminated plaques and ulcerated nodules for 6 weeks. He had weight loss and generalized lymphadenopathy. Underlying diseases were not known up till then. Based on a skin biopsy, the diagnosis of CD8‐positive cutaneous T‐cell lymphoma, type mycosis fungoides was made in a pathological reference center for lymphoma. A reproducible T‐cell receptor (TCR)‐beta rearrangement was detectable. Before starting therapy, a new biopsy was taken and the previous diagnosis was re‐evaluated taking clinical images and symptoms into account. Based on both, the diagnosis of a CD8+ pseudolymphoma in lues maligna and human immunodeficiency virus was made. We highlight histopathologic clues for the correct diagnosis, and we emphasize the indispensability of clinical‐pathological correlation. Furthermore, we discuss the differential diagnosis of CD8+ lymphoproliferative disorders.

T‐cell pseudolymphoma in recurrent herpes simplex virus infection

“…Considering the numerous admixed CD4+ histiocytes in pseudolymphomatous reactions, this observation seems to be due to the presence of both CD4+ lymphocytes and CD4+ histiocytes in the dermis. Important differential diagnoses include pseudolymphomas caused by other infectious agents (eg, fungi, Borrelia burgdorferi , syphilis, HIV, mycobacteria) and based on our previous observations infiltrates in the early stage of scleroderma. The lack of detection of a monoclonal expansion of T‐cells in our cases argues also for a reactive process, even if a monoclonal TCR is not detectable in all cutaneous lymphomas.…”

Cutaneous pseudolymphoma—A review on the spectrum and a proposal for a new classification

“…A special diagnostic challenge is a co‐infection of syphilis (lues maligna) and HIV. In these cases, a predominance of CD8+ lymphocytes can occur and monoclonal TCR rearrangement has been documented simulating CD8+ aggressive epidermotropic CTCL.…”

“…Molecular studies for clonality can be helpful, but should be interpreted only in the clinical context. Clonal T‐ and B‐cells are not specific for lymphoma, and can also occur in inflammatory diseases, infections, and PSL …”

Inflammatory and infectious skin diseases presenting as cutaneous pseudolymphoma

“…Many reactive infiltrates can histologically simulate mycosis fungoides (MF) or other CTCLs perfectly and even monoclonality has been reported. 14 CPC is particularly critical to avoid misdiagnosis in this group. This group encompasses a huge number of different entities, like lymphomatoid contact dermatitis, lymphomatoid drug reactions and a broad spectrum of infections and inflammatory dermatosis.…”