Difference between revisions of "Dermatopathic lymphadenopathy"

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#redirect [[Lymph_node_pathology#Dermatopathic_lymphadenopathy]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Dermatopathic_lymphadenopathy_-_high_mag.jpg
| Width      =
| Caption    = Dermatopathic lymphadenopathy. [[H&E stain]].
| Micro      = sinus histiocytosis with melanin pigment, esoinophils, plasma cells
| Subtypes  =
| LMDDx      = [[malignant melanoma]], [[sinus histiocytosis]], [[Hodgkin lymphoma]]
| Stains    = [[Fontana-Masson stain]]
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph node]] - see ''[[lymph node pathology]]''
| Assdx      = T-cell lymphoma
| Syndromes  =
| Clinicalhx =
| Signs      = enlarged lymph node
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other cause of lymphadenopathy
}}
'''Dermatopathic lymphadenopathy''', abbreviated '''DL''', is a rare [[lymph node pathology|pathology of the lymph nodes]].
 
==General==
*Lymphadenopathy associated with a [[skin]] lesion.
**May not always be true.<ref name=pmid3178430>{{Cite journal  | last1 = Gould | first1 = E. | last2 = Porto | first2 = R. | last3 = Albores-Saavedra | first3 = J. | last4 = Ibe | first4 = MJ. | title = Dermatopathic lymphadenitis. The spectrum and significance of its morphologic features. | journal = Arch Pathol Lab Med | volume = 112 | issue = 11 | pages = 1145-50 | month = Nov | year = 1988 | doi =  | PMID = 3178430 }}</ref>
*Benign in itself.<ref name=pmid17176922>{{Cite journal  | last1 = Westhoff | first1 = TH. | last2 = Loddenkemper | first2 = C. | last3 = Hörl | first3 = MP. | last4 = Schmidt | first4 = S. | last5 = Anagnostopoulos | first5 = I. | last6 = Hummel | first6 = M. | last7 = Zidek | first7 = W. | last8 = van der Giet | first8 = M. | title = Dermatopathic lymphadenopathy: a differential diagnosis of enlarged lymph nodes in uremic pruritus. | journal = Clin Nephrol | volume = 66 | issue = 6 | pages = 472-5 | month = Dec | year = 2006 | doi =  | PMID = 17176922 }}</ref>
**May be associated with a malignancy - esp. T-cell lymphoma.<ref name=pmid5341844>{{Cite journal  | last1 = Cooper | first1 = RA. | last2 = Dawson | first2 = PJ. | last3 = Rambo | first3 = ON. | title = Dermatopathic lymphadenopathy a clinicopathologic analysis of lymph node biopsy over a fifteen-year period. | journal = Calif Med | volume = 106 | issue = 3 | pages = 170-5 | month = Mar | year = 1967 | doi =  | PMID = 5341844 }}
</ref><ref name=pmid15173917>{{Cite journal  | last1 = Kojima | first1 = M. | last2 = Nakamura | first2 = S. | last3 = Itoh | first3 = H. | last4 = Yamane | first4 = Y. | last5 = Shimizu | first5 = K. | last6 = Murayama | first6 = K. | last7 = Ohno | first7 = Y. | last8 = Tanaka | first8 = H. | last9 = Sugihara | first9 = S. | title = Clinical implication of dermatopathic lymphadenopathy among Japanese: a report of 19 cases. | journal = Int J Surg Pathol | volume = 12 | issue = 2 | pages = 127-32 | month = Apr | year = 2004 | doi =  | PMID = 15173917 }}</ref>
 
==Microscopic==
Features:<ref name=ILNP226>{{Ref ILNP|226}}</ref>
*Abundant histiocytes & special histiocytes - in loose irregular clusters - located in the sinuses, i.e. sinus histiocytosis - '''key feature''':
**Do ''not'' form granuloma; may be similar to ''toxoplasma''.
*Plasma cells (medulla).
*Eosinophils.
 
Histiocytes & special histiocytes:
*Histiocytes:
**+/-Melanin pigment '''key feature''' (if present).
**Lipid-laden macrophages.
*Interdigitating dendritic cells:
**Need IHC to identify definitively.
*Langerhans cells:
**Classically have a kidney bean nuclei.
**Need IHC to identify definitively.
 
DDx:
*[[Metastatic]] [[malignant melanoma]] - (melanin) pigmented cells have nuclear atypia, not histiocytes.
*[[Sinus histiocytosis]] - no cells with melanin.
 
===Images===
<gallery>
Image:Dermatopathic_lymphadenopathy_-_very_low_mag.jpg | DL - very low mag. (WC)
Image:Dermatopathic_lymphadenopathy_-_low_mag.jpg | DL - low mag. (WC)
Image:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg | DL - intermed. mag. (WC)
Image:Dermatopathic_lymphadenopathy_-_high_mag.jpg | DL - high mag. (WC)
Image:Dermatopathic_lymphadenopathy_-_very_high_mag.jpg | DL - very high mag. (WC)
</gallery>
 
==IHC==
*Interdigitating dendritic cells: S100 +ve, CD1a -ve.
*Langerhans cells: S100 +ve, CD1a +ve.
 
==See also==
*[[Lymph node pathology]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Lymph node pathology]]

Latest revision as of 03:48, 10 December 2013

Dermatopathic lymphadenopathy
Diagnosis in short

Dermatopathic lymphadenopathy. H&E stain.
LM sinus histiocytosis with melanin pigment, esoinophils, plasma cells
LM DDx malignant melanoma, sinus histiocytosis, Hodgkin lymphoma
Stains Fontana-Masson stain
Site lymph node - see lymph node pathology
Associated Dx T-cell lymphoma
Signs enlarged lymph node
Prevalence uncommon
Prognosis benign
Clin. DDx other cause of lymphadenopathy

Dermatopathic lymphadenopathy, abbreviated DL, is a rare pathology of the lymph nodes.

General

  • Lymphadenopathy associated with a skin lesion.
    • May not always be true.[1]
  • Benign in itself.[2]
    • May be associated with a malignancy - esp. T-cell lymphoma.[3][4]

Microscopic

Features:[5]

  • Abundant histiocytes & special histiocytes - in loose irregular clusters - located in the sinuses, i.e. sinus histiocytosis - key feature:
    • Do not form granuloma; may be similar to toxoplasma.
  • Plasma cells (medulla).
  • Eosinophils.

Histiocytes & special histiocytes:

  • Histiocytes:
    • +/-Melanin pigment key feature (if present).
    • Lipid-laden macrophages.
  • Interdigitating dendritic cells:
    • Need IHC to identify definitively.
  • Langerhans cells:
    • Classically have a kidney bean nuclei.
    • Need IHC to identify definitively.

DDx:

Images

  • DL - very low mag. (WC)

  • DL - low mag. (WC)

  • DL - intermed. mag. (WC)

  • DL - high mag. (WC)

  • DL - very high mag. (WC)

IHC

  • Interdigitating dendritic cells: S100 +ve, CD1a -ve.
  • Langerhans cells: S100 +ve, CD1a +ve.

See also

References

  1. ↑ Gould, E.; Porto, R.; Albores-Saavedra, J.; Ibe, MJ. (Nov 1988). "Dermatopathic lymphadenitis. The spectrum and significance of its morphologic features.". Arch Pathol Lab Med 112 (11): 1145-50. PMID 3178430.
  2. ↑ Westhoff, TH.; Loddenkemper, C.; Hörl, MP.; Schmidt, S.; Anagnostopoulos, I.; Hummel, M.; Zidek, W.; van der Giet, M. (Dec 2006). "Dermatopathic lymphadenopathy: a differential diagnosis of enlarged lymph nodes in uremic pruritus.". Clin Nephrol 66 (6): 472-5. PMID 17176922.
  3. ↑ Cooper, RA.; Dawson, PJ.; Rambo, ON. (Mar 1967). "Dermatopathic lymphadenopathy a clinicopathologic analysis of lymph node biopsy over a fifteen-year period.". Calif Med 106 (3): 170-5. PMID 5341844.
  4. ↑ Kojima, M.; Nakamura, S.; Itoh, H.; Yamane, Y.; Shimizu, K.; Murayama, K.; Ohno, Y.; Tanaka, H. et al. (Apr 2004). "Clinical implication of dermatopathic lymphadenopathy among Japanese: a report of 19 cases.". Int J Surg Pathol 12 (2): 127-32. PMID 15173917.
  5. ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 226. ISBN 978-0781775960.
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