Thursday, March 30, 2006

Unknown

What are your thoughts?






The Pathology Report: ATYPICAL LYMPHOID HYPEPLASIA
"Superficial and deep, nodular and diffuse lymphohistiocytic infiltrate forming follicular germinal centers consistent with atypical lymphoid hyperplasia.

NOTE : Immunostaining reveals a mixture of T-cells (CD3) and B-cells (CD-20). No clonal proliferation is seen on Kappa and Lambda staining. No CD-30 positive cells are noted. These findings are supportive of a lymphoid hyperplasia. If the clinical suspicion persists, follow-up of the patient is suggested"

Given the location, one wonders if this could be secondary to a tick bite (common in our area). See; Pediatr Dermatol. 2001 Nov-Dec;18(6):481-4.

Persistent atypical lymphocytic hyperplasia following tick bite in a child:
report of a case and review of the literature.

Hwong H, Jones D, Prieto VG, Schulz C, Duvic M.

Department of Internal Medicine Specialties, Section of Dermatology, University
of Texas-M.D. Anderson Cancer Center, Houston, Texas 77030, USA.

We report a 6-year-old girl who developed a red papule on the posterior neck at
the site of a previous tick bite. Initial biopsy was performed a year after the
bite and the specimen showed a dense lymphoid infiltrate with admixed CD30+
cells. The patient was referred to our center because of concern about the
development of a CD30+ lymphoproliferative disorder. The lesion was completely
excised. Histology showed no evidence of a clonal lymphoproliferative disorder
or Borrelia infection, but persistence of CD30+ cells. This case demonstrates
that a tick bite reaction can persist for more than 1 year and show
immunophenotypic and morphologic overlap with a CD30+ lymphoproliferative
disorder. Complete history with thorough clinical and histopathologic evaluation
is necessary to arrive at the correct diagnosis.


The patient is a 52 yo engineer who presents with a 2 month history of a 1.5 cm in diameter asymptomatic somewhat "spongy" presternal nodule surrounded on one side with macular non-blanchable erythema.
The clinical appearance is non-diagnostic. This may be an infiltrative process, possibly a malignancy. I have not seen anything like this before with the possible exception of a Merkel Cell carcinoma. Punch biopsies were taken from the nodule and the surrounding erythema.
The results should be back on April 3.


What are your thoughts?

4 comments:

  1. Looks like lupus vulgaris to me.

    ReplyDelete
  2. Every day we might face such odd cases .This stimulate the fantasy in dermatology.I will consider the possibilty of lymphoma cutis,B-cell lyphoma or condition related to panniculitis

    khalifa sharquie

    ReplyDelete
  3. Abbas AlshammariApril 01, 2006

    I would to prefer more details regarding history and physical examination.In such odd cases these details may shorten a long list of differential diagnoses.I agree ,it may be cutaneous TB or as my teacher's comment a cutaneous lymphoma.The authors described the lesion as spongy with non blanchable erythema .may be one of the vascular tumours??

    ReplyDelete
  4. I have to revise my opinion with the histopathology report.
    Friends, I wonder why no one thinks of Kimura's 'ANGIOLYMPHOID HYPERPLASIA'. Is there any tissue or peripheral eosinophilia.
    Food for thought!

    ReplyDelete

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