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Cutaneous T cell pseudolymphomas

Rein Willemze, MD
Section Editor
John A Zic, MD
Deputy Editor
Rosamaria Corona, MD, DSc


The term cutaneous pseudolymphoma refers to a heterogeneous group of benign skin disorders that simulate cutaneous lymphomas histologically and sometimes clinically. Cutaneous pseudolymphomas can be separated into two major subtypes, pseudolymphomas mimicking a cutaneous B cell lymphoma and pseudolymphomas mimicking a cutaneous T cell lymphoma (table 1) [1,2].

Histologically, cutaneous T cell pseudolymphomas may show a superficial band-like pattern simulating early patch/plaque-stage mycosis fungoides (MF) or a nodular or diffuse pattern simulating peripheral T cell lymphoma, not otherwise specified (PTCL, NOS) or tumor-stage MF. Examples of the first category include lymphomatoid contact dermatitis, lymphomatoid drug eruptions, and actinic reticuloid; examples of the second category include persistent arthropod reactions and nodular scabies. However, in most cases the cause is unknown. Such idiopathic cutaneous pseudo-T-cell lymphomas may have a band-like superficial pattern or a nodular or diffuse pattern.

This topic will focus on distinct clinicopathologic entities commonly included in the spectrum of cutaneous T cell pseudolymphomas. Other mimickers of early-stage MF or primary cutaneous CD30+ lymphoproliferative disorders, as well as HIV- and other immunodeficiency-related CD8+ cutaneous pseudolymphomas will be briefly discussed. Cutaneous T cell lymphomas, lymphomatoid papulosis, and cutaneous B cell pseudolymphomas are discussed separately.

(See "Classification of primary cutaneous lymphomas".)

(See "Clinical manifestations, pathologic features, and diagnosis of mycosis fungoides".)

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Literature review current through: Nov 2017. | This topic last updated: May 11, 2017.
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  1. Rijlaarsdam JU, Willemze R. Cutaneous pseudolymphomas: classification and differential diagnosis. Semin Dermatol 1994; 13:187.
  2. Ploysangam T, Breneman DL, Mutasim DF. Cutaneous pseudolymphomas. J Am Acad Dermatol 1998; 38:877.
  3. Ive FA, Magnus IA, Warin RP, Jones EW. "Actinic reticuloid"; a chronic dermatosis associated with severe photosensitivity and the histological resemblance to lymphoma. Br J Dermatol 1969; 81:469.
  4. Paek SY, Lim HW. Chronic actinic dermatitis. Dermatol Clin 2014; 32:355.
  5. Toonstra J, Henquet CJ, van Weelden H, et al. Actinic reticuloid. A clinical photobiologic, histopathologic, and follow-u study of 16 patients. J Am Acad Dermatol 1989; 21:205.
  6. Sidiropoulos M, Deonizio J, Martinez-Escala ME, et al. Chronic actinic dermatitis/actinic reticuloid: a clinicopathologic and immunohistochemical analysis of 37 cases. Am J Dermatopathol 2014; 36:875.
  7. Yap LM, Foley P, Crouch R, Baker C. Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology clinic. Australas J Dermatol 2003; 44:256.
  8. Agar N, Morris S, Russell-Jones R, et al. Case report of four patients with erythrodermic cutaneous T-cell lymphoma and severe photosensitivity mimicking chronic actinic dermatitis. Br J Dermatol 2009; 160:698.
  9. Willemze R, Jaffe ES, Burg G, et al. WHO-EORTC classification for cutaneous lymphomas. Blood 2005; 105:3768.
  10. Bakels V, van Oostveen JW, Preesman AH, et al. Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor gamma gene rearrangement analysis and immunophenotyping. J Clin Pathol 1998; 51:154.
  11. Orbaneja JG, Diez LI, Lozano JL, Salazar LC. Lymphomatoid contact dermatitis: a syndrome produced by epicutaneous hypersensitivity with clinical features and a histopathologic picture similar to that of mycosis fungoides. Contact Dermatitis 1976; 2:139.
  12. Knackstedt TJ, Zug KA. T cell lymphomatoid contact dermatitis: a challenging case and review of the literature. Contact Dermatitis 2015; 72:65.
  13. Kardaun SH, Scheffer E, Vermeer BJ. Drug-induced pseudolymphomatous skin reactions. Br J Dermatol 1988; 118:545.
  14. Rijlaarsdam U, Scheffer E, Meijer CJ, et al. Mycosis fungoides-like lesions associated with phenytoin and carbamazepine therapy. J Am Acad Dermatol 1991; 24:216.
  15. Nathan DL, Belsito DV. Carbamazepine-induced pseudolymphoma with CD-30 positive cells. J Am Acad Dermatol 1998; 38:806.
  16. Kabashima R, Orimo H, Hino R, et al. CD30-positive T-cell pseudolymphoma induced by amlodipine. J Eur Acad Dermatol Venereol 2008; 22:1522.
  17. Sawada Y, Yoshiki R, Kawakami C, et al. Valsartan-induced drug eruption followed by CD30+ pseudolymphomatous eruption. Acta Derm Venereol 2010; 90:521.
  18. Pulitzer MP, Nolan KA, Oshman RG, Phelps RG. CD30+ lymphomatoid drug reactions. Am J Dermatopathol 2013; 35:343.
  19. Magro CM, Crowson AN. Drug-induced immune dysregulation as a cause of atypical cutaneous lymphoid infiltrates: a hypothesis. Hum Pathol 1996; 27:125.
  20. Luelmo Aguilar J, Mieras Barceló C, Martín-Urda MT, et al. Generalized cutaneous B-cell pseudolymphoma induced by neuroleptics. Arch Dermatol 1992; 128:121.
  21. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol 2013; 169:1071.
  22. D'Incan M, Souteyrand P, Bignon YJ, et al. Hydantoin-induced cutaneous pseudolymphoma with clinical, pathologic, and immunologic aspects of Sézary syndrome. Arch Dermatol 1992; 128:1371.
  23. Reeder MJ, Wood GS. Drug-induced pseudo-Sezary syndrome: a case report and literature review. Am J Dermatopathol 2015; 37:83.
  24. Ortonne N, Valeyrie-Allanore L, Bastuji-Garin S, et al. Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: a morphological and phenotypical study. Br J Dermatol 2015; 173:50.
  25. Callot V, Roujeau JC, Bagot M, et al. Drug-induced pseudolymphoma and hypersensitivity syndrome. Two different clinical entities. Arch Dermatol 1996; 132:1315.
  26. Werner B, Massone C, Kerl H, Cerroni L. Large CD30-positive cells in benign, atypical lymphoid infiltrates of the skin. J Cutan Pathol 2008; 35:1100.
  27. Jung J, Levin EC, Jarrett R, et al. Lymphomatoid drug reaction to ustekinumab. Arch Dermatol 2011; 147:992.
  28. Saeed SA, Bazza M, Zaman M, Ryatt KS. Cefuroxime induced lymphomatoid hypersensitivity reaction. Postgrad Med J 2000; 76:577.
  29. Fukamachi S, Sugita K, Sawada Y, et al. Drug-induced CD30+ T cell pseudolymphoma. Eur J Dermatol 2009; 19:292.
  30. Sangueza OP, Cohen DE, Calciano A, et al. Mycosis fungoides induced by phenytoin. Eur J Dermatol 1993; 3:474.
  31. Magro CM, Crowson AN, Kovatich AJ, Burns F. Drug-induced reversible lymphoid dyscrasia: a clonal lymphomatoid dermatitis of memory and activated T cells. Hum Pathol 2003; 34:119.
  32. Rijlaarsdam JU, Scheffer E, Meijer CJ, Willemze R. Cutaneous pseudo-T-cell lymphomas. A clinicopathologic study of 20 patients. Cancer 1992; 69:717.
  33. Smolle J, Torne R, Soyer HP, Kerl H. Immunohistochemical classification of cutaneous pseudolymphomas: delineation of distinct patterns. J Cutan Pathol 1990; 17:149.
  34. Rodríguez Pinilla SM, Roncador G, Rodríguez-Peralto JL, et al. Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma expresses follicular T-cell markers. Am J Surg Pathol 2009; 33:81.
  35. Cetinözman F, Jansen PM, Willemze R. Expression of programmed death-1 in primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoma, cutaneous pseudo-T-cell lymphoma, and other types of cutaneous T-cell lymphoma. Am J Surg Pathol 2012; 36:109.
  36. Leinweber B, Beltraminelli H, Kerl H, Cerroni L. Solitary small- to medium-sized pleomorphic T-cell nodules of undetermined significance: clinical, histopathological, immunohistochemical and molecular analysis of 26 cases. Dermatology 2009; 219:42.
  37. Langerak AW, Groenen PJ, Brüggemann M, et al. EuroClonality/BIOMED-2 guidelines for interpretation and reporting of Ig/TCR clonality testing in suspected lymphoproliferations. Leukemia 2012; 26:2159.
  38. Beltraminelli H, Leinweber B, Kerl H, Cerroni L. Primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma: a cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance? A study of 136 cases. Am J Dermatopathol 2009; 31:317.
  39. Alberti-Violetti S, Torres-Cabala CA, Talpur R, et al. Clinicopathological and molecular study of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma. J Cutan Pathol 2016; 43:1121.
  40. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127:2375.
  41. Garcia-Herrera A, Colomo L, Camós M, et al. Primary cutaneous small/medium CD4+ T-cell lymphomas: a heterogeneous group of tumors with different clinicopathologic features and outcome. J Clin Oncol 2008; 26:3364.
  42. Arai E, Shimizu M, Tsuchida T, et al. Lymphomatoid keratosis: an epidermotropic type of cutaneous lymphoid hyperplasia: clinicopathological, immunohistochemical, and molecular biological study of 6 cases. Arch Dermatol 2007; 143:53.
  43. Bachelez H, Hadida F, Gorochov G. Massive infiltration of the skin by HIV-specific cytotoxic CD8+ T cells. N Engl J Med 1996; 335:61.
  44. Guitart J, Variakojis D, Kuzel T, Rosen S. Cutaneous CD8 T cell infiltrates in advanced HIV infection. J Am Acad Dermatol 1999; 41:722.
  45. Schartz NE, De La Blanchardiére A, Alaoui S, et al. Regression of CD8+ pseudolymphoma after HIV antiviral triple therapy. J Am Acad Dermatol 2003; 49:139.
  46. Ingen-Housz-Oro S, Sbidian E, Ortonne N, et al. HIV-related CD8+ cutaneous pseudolymphoma: efficacy of methotrexate. Dermatology 2013; 226:15.
  47. Marzano AV, Berti E, Alessi E, Caputo R. Clonal CD8 infiltration of the skin in common variable immunodeficiency: a prelymphomatous stage? J Am Acad Dermatol 2001; 44:710.
  48. Schuetz C, Huck K, Gudowius S, et al. An immunodeficiency disease with RAG mutations and granulomas. N Engl J Med 2008; 358:2030.
  49. Gammon B, Robson A, Deonizio J, et al. CD8(+) granulomatous cutaneous T-cell lymphoma: a potential association with immunodeficiency. J Am Acad Dermatol 2014; 71:555.
  50. Citarella L, Massone C, Kerl H, Cerroni L. Lichen sclerosus with histopathologic features simulating early mycosis fungoides. Am J Dermatopathol 2003; 25:463.
  51. Fink-Puches R, Wolf P, Kerl H, Cerroni L. Lichen aureus: clinicopathologic features, natural history, and relationship to mycosis fungoides. Arch Dermatol 2008; 144:1169.
  52. Horn TD, Abanmi A. Analysis of the lymphocytic infiltrate in a case of vitiligo. Am J Dermatopathol 1997; 19:400.
  53. Petit T, Cribier B, Bagot M, Wechsler J. Inflammatory vitiligo-like macules that simulate hypopigmented mycosis fungoides. Eur J Dermatol 2003; 13:410.