Primary cutaneous follicle center lymphoma with Hodgkin and Reed‐Sternberg‐like cells: a new histopathologic variant

Abstract

Primary cutaneous follicle center lymphoma (PCFCL) is the most frequent cutaneous B-cell lymphoma. A 62-year-old man presented with a solitary indolent subcutaneous nodule for 3 years duration, without other abnormalities. Histological examination showed lymphoproliferation with a nodular growth pattern characterized by fibrous collagen bands surrounding nodules. The nodules were composed of medium-sized centrocytes admixed with many large multilobulated and lacunar cells without eosinophils or granulomatous aspect. Hodgkin-like cells were CD30+, CD15+, PAX5+, OCT2+, BOB1+, MUM1+, Ki67+, Bcl6+ and focally CD20+ and EMA-, CD79a-, Bcl2- and CD10-. The medium-sized cells were CD20+, CD79a+, Bcl2+, Bcl6+ and CD10+, enmeshed in a network of CD21-positive follicular dendritic cells. Epstein-Barr virus detection was negative. Interphase fluorescence in situ hybridization showed the absence of BCL2 or BCL6 rearrangement. In such a case, the presence of Hodgkin-like cells intermixed with the tumor population may result in a pitfall diagnosis of classical Hodgkin lymphoma (CHL). Differential diagnoses to be ruled out are secondary or primary skin localization of rather CHL, or systemic follicular lymphoma. Several clinical, radiological, histological, immunohistochemical and molecular arguments indicated the diagnosis of PCFCL. To our knowledge, this is the first report of PCFCL with Hodgkin-like cells.

Deep Sequencing of Immunoglobulin Genes Identifies a Very Low Percentage of Monoclonal B Cells in Primary Cutaneous Marginal Zone Lymphomas with CD30-Positive Hodgkin/Reed–Sternberg-like Cells

“…Among malignancies, CD30-positive T-cells typically characterize lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (cALCL) [ 1 , 36 ], whereas in B-cell neoplasms CD30-positive cells are less common, occurring in the setting of iatrogenic immunosuppression (i.e., mucocutaneous ulcers) [ 1 , 37 ], and in primary cutaneous diffuse large B-cell lymphomas (DLBCL) [ 38 ]. CD30 expression has also been reported in a variable number of neoplastic cells of primary cutaneous follicle center lymphoma (PCFCL) and of primary cutaneous marginal zone lymphoma (PCMZL) [ 14 , 15 , 39 , 40 , 41 , 42 ], with rare cases describing a Hodgkin and Reed–Sternberg (H/RS)-like morphology [ 26 , 43 , 44 ].…”

Secondary skin involvement in classic Hodgkin lymphoma: Results of an international collaborative cutaneous lymphoma working group study of 25 patients

“…[11][12][13][14][16][17][18][19] The most recent studies showed an incidence of <0.5% of skin infiltration. 15 The marked decrease in the (eg, primary cutaneous follicle center and cutaneous marginal zone lymphoma) [25][26][27] (summarized in Table 3). LyP is characterized by the presence of small papules or nodules, with or without ulceration, that spontaneously heal with scarring, over the course of weeks.…”

Primary Cutaneous Follicle Centre Lymphoma with Hodgkin and Reed-Sternberg Like Cells: A Case Report and Review of the Literature

“…The proliferative index Ki67 in the PCFCL was estimated at 20%. PCR and FISH studies did not detect the presence of the t (14; 18) translocation [ 30 ]. The comparison between these two isolated cases may suggest that the PCFCLs associated with H/RS cells have low-proliferation rates and appear clinically indolent.…”