Chow Kar Fai, Ritchie Ellen, Husain Sameera, Alobeid Bachir, Bhagat Govind
Department of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY 10032, USA.
J Cutan Pathol. 2011 Jun;38(6):483-91. doi: 10.1111/j.1600-0560.2011.01697.x. Epub 2011 Mar 6.
An infiltrate mimicking subcutaneous panniculitis associated with a granulomatous response represents an uncommon histopathologic presentation of lymphoma. We report three cases, comprising one case each of nasal-type extranodal NK/T-cell lymphoma, cutaneous γ/δ T-cell lymphoma and human T-lymphotropic virus-I associated adult T-cell leukemia/lymphoma, which based on initial histopathologic and/or clinical presentation were thought to represent systemic lupus erythematosus, sarcoidosis and psoriasiform dermatitis, respectively. Excisional biopsies of indurated lesions performed at our institute; however, in each case showed an atypical subcutaneous lymphohistiocytic infiltrate associated with a variable number of granulomas. Extensive immunophenotypic characterization, in conjunction with histomorphologic and molecular analysis, established the diagnosis of lymphoma in all instances. All patients had a rapidly progressive clinical course and death was attributable to complications of lymphoma shortly after diagnosis. These cases highlight the importance of using a multimodality diagnostic approach to distinguish lymphomas masquerading as granulomatous panniculitis from inflammatory or reactive disorders associated with such histopathologic patterns.
一种伴有肉芽肿反应、酷似皮下脂膜炎的浸润表现为淋巴瘤罕见的组织病理学表现。我们报告3例病例，分别为鼻型结外NK/T细胞淋巴瘤、皮肤γ/δ T细胞淋巴瘤和人类嗜T淋巴细胞病毒I型相关成人T细胞白血病/淋巴瘤各1例，基于最初的组织病理学和/或临床表现，它们分别被认为是系统性红斑狼疮、结节病和银屑病样皮炎。在我们研究所对硬结性病变进行了切除活检；然而，每例均显示非典型皮下淋巴细胞组织细胞浸润，并伴有数量不等的肉芽肿。广泛的免疫表型特征分析，结合组织形态学和分子分析，在所有病例中均确诊为淋巴瘤。所有患者临床病程进展迅速，诊断后不久均因淋巴瘤并发症死亡。这些病例凸显了采用多模态诊断方法以区分伪装成肉芽肿性脂膜炎的淋巴瘤与具有此类组织病理学模式的炎症性或反应性疾病的重要性。
