From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan.
Arch Pathol Lab Med. 2019 Aug;143(8):958-979. doi: 10.5858/arpa.2018-0294-RA.
CONTEXT.—: The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy).
OBJECTIVE.—: To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates.
DATA SOURCES.—: An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors.
CONCLUSIONS.—: A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
评估皮肤淋巴样浸润，无论是肿瘤性还是炎症性，在常规皮肤病理检查和会诊实践中非常常见。许多病理学家都害怕“棘手”的皮肤淋巴样浸润；皮肤活检相对较小，而诊断的可能性相对广泛。诚然，皮肤淋巴瘤的诊断可能很困难，在许多情况下，需要多次活检才能得出正确的诊断结果。需要提醒的是，应该明白，低度皮肤淋巴瘤是惰性疾病，通常会持续数十年，而且治疗并不能治愈疾病。同样重要的是要记住，在大多数情况下，这些患者会死于与皮肤淋巴瘤诊断完全无关的其他过程（即使没有特定的治疗）。
使用临床病理、免疫表型和分子方法评估常见的淋巴细胞浸润。
对皮肤淋巴瘤领域的最新文献进行了深入分析，特别强调了最近世界卫生组织皮肤和血液肿瘤分类中的最新术语。
可以使用所提出的系统，通过系统方案来充分处理皮肤淋巴样浸润的诊断。总体而言，皮肤 T 细胞和 B 细胞淋巴瘤较为罕见，而“反应性”浸润更为常见。评估淋巴样增殖应从对病变临床表现、临床鉴别考虑的良好了解、以及认真和适当使用免疫组织化学和分子工具开始。
