Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin PDF
Preview Cutaneous Hematopathology: Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infiltrates in Skin
Hernani D. Cualing Marshall E. Kadin Mai P. Hoang Michael B. Morgan Editors Cutaneous Hematopathology Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infi ltrates in Skin 123 Cutaneous Hematopathology Hernani D. Cualing (cid:129) Marshall E. Kadin Mai P. Hoang (cid:129) Michael B. Morgan Editors Cutaneous Hematopathology Approach to the Diagnosis of Atypical Lymphoid-Hematopoietic Infi ltrates in Skin Editors Hernani D. Cualing, MD Mai P. Hoang, MD Department of Hematopathology Department of Pathology IHCFLOW Diagnostic Laboratory Harvard Medical School Lutz , FL Massachusetts General Hospital USA Boston , MA USA Marshall E. Kadin, MD Department of Dermatology Michael B. Morgan, MD Roger Williams Medical Center Pensacola and Atlanta Boston University School of Medicine Dermpath Diagnostics Providence , RI University of South Florida USA College of Medicine Tampa , FL USA ISBN 978-1-4939-0949-0 ISBN 978-1-4939-0950-6 (eBook) DOI 10.1007/978-1-4939-0950-6 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2014945353 © Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) I dedicate the book to my loving wife, Rawia, also to Kareem, Phillip, and Andrew and to my parents Flor and Pablo Cualing; for their support made it possible to accomplish this goal. Hernani D. Cualing, MD I dedicate my contribution to my beloved wife, Martha L. Hutchinson, MD, PhD, who supports all my academic pursuits. Marshall E. Kadin, MD To Hòa and Talya. Mai P. Hoang, MD For Sister Sara (Norfolk Catholic High School), Dr. Eileen Gregory (Rollins College), Drs. David Rowland, Peter Dawson and Henry Azar (University of South Florida College of Medicine), and Dr. Mark Everett (University of Oklahoma); preeminent among many, they inculcated an unerring fascination with science and commitment to excellence in medicine for whom I am eternally grateful and indebted. Michael B. Morgan, MD Foreword This effort fi lls a much needed niche for the fi elds of both dermatopathology and hematopathology. The interpretation of lymphoid infi ltrates in the skin is one of the most challenging problems for practitioners from both disciplines. Dermatopathologists, while comfortable examining lymphocytic reaction patterns, are often confused by the subtleties of immunohistochemical pro- fi les, cytometric studies, and molecular data that further delineate the nature of the infi ltrating cells. In general, their experience with various, relatively uncommon, subtypes of lymphoma is limited and the data seems overwhelm- ing. In contrast, hematopathologists have a great deal of experience interpret- ing these ancillary tests, but do not frequently encounter the subtle histologic patterns that characterize cutaneous lymphoid infi ltrates, benign or malignant. T he authors have attempted to and have succeeded in conquering a dif- fi cult task. The divergent approaches to the study of cutaneous lymphoid infi ltrates are no better exemplifi ed than in the long history of lymphoma classifi cation schemes that have populated the literature (and confused prac- titioners) for many decades. In this work, the authors, a group of well-known and experienced hematopathologists and dermatopathologists, have worked together to create a rational, logical, and thoughtful approach to these dif- fi cult cutaneous lesions. Virtually all of the malignant lymphocytic infi ltrates that are encountered in the skin are described within the volume alongside benign lymphocytic reaction patterns that might provide the observer with a diagnostic dilemma. Routine histologic changes are presented as a starting point to which the authors have added a comprehensive discussion of immu- nohistochemistry, molecular and fl ow cytometry data that characterize each of the entries. The authors have included lucid photomicrographs that cap- ture the salient diagnostic features. The organizational structure of the book enables the reader to refer to the section of the book that addresses a particu- lar histologic pattern. Within this section, both benign and malignant infi l- trates are described, with the text and accompanying photographic images highlighting the most useful discriminating data. This logical approach more realistically addresses the concerns of the pathologist attempting to arrive at a correct diagnosis than does the frequent approach in which benign enti- ties are described sequentially, followed by a description of the cutaneous lymphomas. S everal features differentiate this work from previous volumes that address similar topics. Other works that describe cutaneous lymphomas have concentrated almost entirely upon this body of diseases with only passing vii viii Foreword comments dedicated to histologic mimics of these malignancies. In this vol- ume, the authors confront the real-world situation of presenting to the reader differential diagnoses that go beyond subtyping lymphoma but also provide side-by- side discussions of benign lesions that might give rise to diagnostic confusion. This volume provides up-to-date information regarding the ancil- lary tests that are crucial for arriving at a precise diagnosis in this rapidly evolving fi eld. Such information was not readily available to practitioners when the classic books in the fi eld were written. Perhaps most importantly, this work demonstrates a collaborative effort by hematopathologists and dermatopathologists. By putting together a text that accurately portrays the observations and conclusions from each of the disciplines, the authors have created a unifying approach and have succeeded in giving the reader a com- prehensive and logical approach to this very complicated set of diagnoses. Rochester, NY, USA Bruce Smoller , MD Pref ace Cutaneous Atypical Lymphoid Infi ltrate: A Morphologic Approach to Diagnosis The diffi culty in diagnosis of cutaneous atypical lymphoid infi ltrate is well known to both hematopathologists and dermatologists. Hence, it is not uncommon to have multiple biopsies to arrive at a diagnosis of cutaneous lymphoma. Part of the diffi culty is the wide clinical and pathological overlap between reactive and malignant lymphoid infi ltrate in the skin. The other rea- son may be the lack of a framework to classify these lesions, which may also be related to the fact that a select few hematopathologists and dermatopathol- ogists specialize in these relatively rare, diffi cult to diagnose and confusing disease. Often the lack of clinical history exacerbates the limited microscopic view that a pathologist initially sees. In addition, many autochthonous and exotic tropical infectious diseases present with features that mimic lympho- mas in skin. This book was written to address a need for a systematic pattern-based framework to diagnose lymphomas and pseudolymphomas in the skin. In this handbook, we use an approach used by many hematopathologists and dermatopathologists, in their approach to diagnose lymphomas and atypical lymphoid infi ltrates: begin with the histologic and phenotypic pattern that point to a classifi cation subset, and use clinical, morphological, immunohis- tochemical, and molecular criteria to differentiate pseudolymphomatous and lymphomatous entities under consideration. This book is written to address these issues for the benefi t of hematopathologists and dermatopathologists who will entertain a diagnosis of an atypical infi ltrate in skin that looks like a lymphoma. Hence, the selection of contributors was based on active prac- titioners who diagnose pseudolymphomas, lymphomas, and infections of the skin. Trainees and residents of both disciplines may also fi nd these references basic in their understanding of these diseases. Finally, clinicians may refer to these categories and fi nd covered terms useful in reading reports. This handbook addresses this topic using a unique approach prof- fered from the perspective of hematopathologists together with derma- topathologists. In evaluating a complex set of nearly 120 unique diseases, there is close interaction among hematopathologists, surgical pathologists, d ermatopathologists, dermatologists, and infectious disease specialists. We emphasized an a rchitectural approach using morphologic and immunologic patterns as a starting point and providing an algorithmic path leading to the ix
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