Lupus Profundus (Panniculitis): A Potential Mimic of Subcutaneous Panniculitis-like T-Cell Lymphoma

Abstract

Lupus profundus is a rare manifestation of cutaneous lupus erythematosus, seen in 1% to 3% of patients. It most commonly presents in association with classic chronic cutaneous lesions of discoid lupus erythematosus; however, such lesions, as well as a clinical history of lupus erythematosus, may be lacking. The differential diagnosis for lymphocytic lobular panniculitides is broad; however, the consideration of subcutaneous panniculitis-like T-cell lymphoma is most critical. Recently, there have been several reports emphasizing the overlapping histomorphologic features between lupus profundus and subcutaneous panniculitis-like T-cell lymphoma. Although this is controversial, some authors suggest that patients with lupus profundus are at risk for the development of abnormal, clonal T-cell proliferations and/or overt subcutaneous panniculitis-like T-cell lymphoma. In cases of atypical lymphocytic lobular panniculitis that fail to meet diagnostic criteria for subcutaneous panniculitis-like T-cell lymphoma, patients should be clinically followed indefinitely, as future subcutaneous lymphoma cannot be excluded.

Clinicopathologic, immunophenotypic, and molecular analysis of subcutaneous panniculitis‐like T‐cell lymphoma: A retrospective study in a tertiary care center

“…Histopathological criteria favoring LEP include epidermal and dermal changes of LE, dermal mucin deposition, lymphoid follicles with reactive germinal centers, mixed cell infiltrate with prominent plasma cells, plasmacytoid dendritic cells, hyaline or lipomembranous fat necrosis and polyclonal TCR-U gene rearrangement. 10,[19][20][21][22] Histopathological criteria favoring SPTL include moderate to marked nuclear atypia with adipocyte rimming with a fat necrosis pattern that is more probably to be fibrinoid or coagulative. 10,19 Our study found some overlapping features of SPTL with LEP including vacuolar alteration, periadnexal involvement, and prominent plasma cells.…”

Fatal Case of Subcutaneous Panniculitis T-Cell Lymphoma Mimicking Polyarteritis Nodosa: A Case Report and Review of Literature

“…A variety of diseases, especially dermatological and rheumatic conditions, may have an appearance and presentation similar to SPTL. These include conditions such as septal panniculitis (erythema nodosum), lobular panniculitides (erythema induratum, nodular vasculitis, and lupus panniculitis), lobular and septal panniculitis (alpha-1 antitrypsin deficiency panniculitis), infectious panniculitis, pyoderma gangrenosum, systemic vasculitis and inflammatory myopathies [2][3][4][5]. Histopathologic examination shows subcutaneous infiltrates containing a mixture of neoplastic pleomorphic cells of varying sizes and macrophages and rimming of individual fat cells by neoplastic cells are features of SPTL (Fig.…”

Lupus profundus limited to a site of trauma: Case report and review of the literature

“…The distinction is based on routine histology, immunofluorescence, and serology. The particularly troublesome differential diagnosis is SPTCL (Arps and Patel, 2013). …”