DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.

Tuesday, December 8, 2009

Answer of Dermatopathology Case 8

Cutaneous Lymphadenoma

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Glandular congenital lymphadenoma. Pediatr Dermatol. 2007 Sep-Oct;24(5):547-50.
Cutaneous lymphadenoma is known to occur over a broad age range, from 14 to 72 years of age. We report the unique clinical and histologic presentation of acutaneous lymphadenoma from the suprapubic abdomen of a neonate which may represent a novel subtype, glandular congenital lymphadenoma. Cutaneous lymphadenoma is a rare tumor with a distinct histologic triad of epithelial nodules, dense fibrous stroma, and intense intranodular lymphocytic infiltrate.Typically, it is a slow growing, skin colored papule, nodule, or plaque,clinically resembling a basal cell carcinoma and often occurring in the head and neck region or lower extremities.

Cutaneous lymphadenoma. J Am Acad Dermatol. 2003 Dec;49(6):1115-6.
Cutaneous lymphadenoma is a rare tumor with distinctive histologic features. This entity was originally described as lymphoepithelial tumor by Santa Cruz and Barr in 1987. It was renamed cutaneous lymphadenoma in 1991. To date, at least 31 cases of this entity have been reported. The literature did not contain aclinical photograph of this lesion. A case of this rare tumor is described that includes clinical and histologic features. The literature regarding the unclear histogenesis of this distinctive tumor is reviewed. This report is one of a only few clinical illustrations of cutaneous lymphadenoma. Consistent with previous reports, the histologic findings in this case include basaloid proliferation and intraepithelial lymphocytes. The usual initial clinical diagnosis is basal cell carcinoma localized mainly to the head and neck area. The incidence isapproximately equal in male and female patients. Excision of this benign neoplasmis curative. Controversy exists regarding the histogenesis of this tumor.

Immunohistochemical comparison of cutaneous lymphadenoma, trichoblastoma, andbasal cell carcinoma: support for classification of lymphadenoma as a variant of trichoblastoma.J Cutan Pathol. 1999 Mar;26(3):119-24.
Cutaneous lymphadenoma is an uncommon basaloid epithelial tumor of uncertain histogenesis, most recently classified as a variant of trichoblastoma. Because characteristic immunohistochemical findings have been reported in trichoblastomas, we evaluated the staining patterns of five cutaneous lymphadenomas and compared the results to those of ten trichoblastomas and ten nodular basal cell carcinomas (BCCs), using antibodies to cytokeratin 20 (CK20), bcl-2, and CD34. In addition, because lymphadenomas contain intraepithelial S100-positive putative Langerhans cells, we compared staining of all tumor groups for S100 protein and CD1a. We also attempted to corroborate recent reports ofCD30-positive activated lymphocytes in lymphadenomas. We identified CK20-positive Merkel cells in 3/5 lymphadenomas, 7/10 trichoblastomas, and none of the BCCs. Staining for bcl-2 accentuated the peripheral epithelial layer in all lymphadenomas and in 3/10 trichoblastomas, while the remaining trichoblastomas and all BCCs stained diffusely. There was stromal staining with CD34 in two lymphadenoma, 4 trichoblastomas, and 3 BCCs. All lymphadenomas featured numerous intraepithelial S100-positive cells which were also positive for CD1a in three cases tested. In addition, 8/10 trichoblastomas and 2/10 BCCs contained modest numbers of cells labelling for S100 and CD1a. Two of three lymphadenomas contained rare single cells resembling histiocytes faintly positive for CD30, and similar cells labelled for CD68. We conclude that the similar staining patterns of lymphadenomas and trichoblastomas support the classification of lymphadenoma as a variant of trichoblastoma. Staining with CD34 does not reliably distinguish between these tumors and BCCs. Lymphadenomas, trichoblastomas, and BCCs may all contain Langerhans' cells. The relationship between these cells and the striking lymphoid infiltrates seen in lymphadenomas is not clear. In our cases, the CD30-positive cells in lymphadenomas appear to represent histiocytes rather than activated lymphocytes.