Dermatopathic lymphadenopathy

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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

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.