Plasmacytic cutaneous pathology: A review

Abstract

We review the spectrum of cutaneous disorders associated with inflammatory and neoplastic plasmacytic pathology. Because plasma cells are derived from B‐lymphocytes our overview includes discussion of certain lymphoplasmacytic proliferations. It is structured along histopathological lines, addressing conditions characterized by (a) cutaneous plasma cell infiltrates, (b) deposits of plasma cell products or their derivatives in the skin and (c) miscellaneous, poorly understood cutaneous complications of plasmacytic disorders. Lesions arising primarily in the skin and those due to cutaneous involvement by multisystem disorders are addressed. The range includes a spectrum of tumefactive and circulatory manifestations. We highlight key clinical and pathological features of the different conditions and outline recent advances in our understanding of these entities. By emphasizing the dermatopathological characteristics of this spectrum of disorders we hope to hone the diagnostic accuracy of practitioners in the field.

Cocaine‐induced plasma cell orificial mucositis

“…Histopathologically, diseases with plasma cell infiltrates must be excluded, such as leishmaniasis, syphilis, Lyme disease, rhinoscleroma, IgG4-related disease or neoplasia. 5 However, the presence of a periorificial well-circumscribed, soft, slightly elevated, edematous mass should be a clue to consider PCOM in our differential diagnosis.…”

Retrospective Case Series of Cocaine-Associated Plasma Cell Orificial Mucositis

“…In cases of cutaneous plasma cell infiltrates, the primary concern is excluding neoplastic infiltrations, characterized by monoclonal proliferations with light chain restriction. 9 Within nonneoplastic conditions, a comprehensive differential diagnosis workup should distinguish infections (syphilis, borreliosis, rhinoscleroma, and leishmaniasis), connective tissue disorders, the follicular occlusion tetrad, inflammatory processes affecting plasma cell-friendly environments (mucosal, genitalia and head/neck areas), systemic conditions (cutaneous/systemic plasmacytosis, Castleman disease, and IgG4-related disease), and isolated cutaneous entities, like pretibial lymphoplasmacytic plaque and idiopathic lymphoplasmacellular mucositis-dermatitis (ILPMD). 9,10 PCOM is a term included in the ILPMD entity, as well as plasma cell mucositis, mucous membrane plasmacytosis, or Zoon balanitis.…”

“…9 Within nonneoplastic conditions, a comprehensive differential diagnosis workup should distinguish infections (syphilis, borreliosis, rhinoscleroma, and leishmaniasis), connective tissue disorders, the follicular occlusion tetrad, inflammatory processes affecting plasma cell-friendly environments (mucosal, genitalia and head/neck areas), systemic conditions (cutaneous/systemic plasmacytosis, Castleman disease, and IgG4-related disease), and isolated cutaneous entities, like pretibial lymphoplasmacytic plaque and idiopathic lymphoplasmacellular mucositis-dermatitis (ILPMD). 9,10 PCOM is a term included in the ILPMD entity, as well as plasma cell mucositis, mucous membrane plasmacytosis, or Zoon balanitis. These are characterized by a diagnosis of exclusion for uncertain, benign lymphoplasmacellular infiltrates in the skin and mucosa.…”

Current Insights in Cutaneous Lupus Erythematosus Immunopathogenesis

“…Plasma cells in lupus skin lesions are often observed as "clockface" cells (119). It is not clear whether lupus band reactions arise from local production of autoantibodies in the skin by plasma cells, or if they deposit in the skin from the circulation.…”