The differential diagnosis of cutaneous B-cell infiltrates with follicular pattern of growth is one of the most vexing problems in dermatopathology. In this study we focused on histopathologic, immunophenotypic, and molecular differential diagnostic criteria between Borrelia burgdorferi (Bb)-associated lymphocytoma cutis (LC), primary cutaneous follicle center cell lymphoma (FCCL), and primary cutaneous marginal zone lymphoma (MZL) with reactive germinal centers (GCs). A total of 47 patients were included in the study, including 12 cases of LC (M:F = 2:1; mean age: 38.0; median: 31; range: 9-75), 29 cases of FCCL (M:F = 1.2:1; mean age: 57.5; median: 57; range: 24-97), and 6 cases of MZL (M:F = 1:1; mean age: 63.8; median: 67.5; range: 38-86). In all cases complete phenotypic data were available. In addition, the IgH gene rearrangement and the t(14;18) were analyzed using the polymerase chain reaction technique (PCR) in 41 (FCCL = 27, LC = 10, MZL = 4) and 18 cases (FCCL = 15, LC = 2, MZL = 1), respectively. Histology revealed in all cases of FCCL one or more atypical feature of the follicles including the lack of or a reduced mantle zone, lack of polarization, tendency to confluence, and absence of tingible body macrophages. In most cases of Bb-associated LC, the GCs were devoid of mantle zone, lacked polarization, and revealed tendency to confluence as well, but all cases showed the presence of several tingible body macrophages. In MZL, follicles showed typical features of reactive GCs. Immunohistology revealed a reduced proliferative activity of neoplastic follicles as detected by MIB-1 antibody in 23 of 29 cases of FCCL (79.3%), but only in 1 case of LC (8.3%). Proliferation of the GCs was normal in all cases of MZL. Positivity for CD10 and/or Bcl-6 was found in small clusters outside the follicles in 19 cases of FCCL (65.5%), and in 3 cases of LC (25%), but in no case of MZL. The intensity of CD10 staining on follicular cells on average was stronger in cases of FCCL, but overlapping features could be observed. Finally, staining for Bcl-2 protein was consistently negative on GC cells in cases of LC and MZL, and was positive on a variable proportion of the cells in 8 cases of FCCL (28.6%). Molecular analyses showed no evidence of the t(14;18) in all cases tested. Analysis of the IgH gene rearrangement revealed a monoclonal pattern in 1 of 10 cases of LC (10%), 14 of 27 cases of FCCL (51.9%), and 2 of 4 cases of MZL (50%) tested. In summary, Bb-associated LC and FCCL show sometimes overlapping histopathologic, immunohistochemical, and molecular features, whereas follicles in MZL show clear-cut aspects of reactive GCs. Absence of tingible body macrophages within follicles, reduced proliferation of the follicles as detected by immunohistology, presence of positivity for Bcl-2 protein within follicular cells, and monoclonality by PCR are the main criteria suggestive of malignancy. Diagnosis of cutaneous infiltrates of B lymphocytes with follicular growth pattern should be achieved by integration of clinical data with histopathologic, immunohistochemical, and molecular features of the lesions.
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Acad Med
September 2023
C.P. Pang is S.H. Ho Research Professor of Visual Science, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Purpose: To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.
Method: Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module.
Int J Radiat Oncol Biol Phys
November 2013
University of British Columbia, Vancouver, Canada; Radiation Therapy Program, BC Cancer Agency, Vancouver, Canada. Electronic address:
Purpose: To review the treatment and outcomes of patients with primary cutaneous B-cell lymphoma (CBCL).
Methods And Materials: Clinical characteristics, treatment, and outcomes were analyzed for all patients referred to our institution from 1981 through 2011 with primary CBCL without extracutaneous or distant nodal spread at diagnosis (n=136). Hematopathologists classified 99% of cases using the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) guidelines.
Leuk Lymphoma
March 2006
Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Germany.
Polymerase chain reaction (PCR)-based detection of clonal T- and B-cells is widely used in the diagnosis of various lymphomas, including those of the skin. A large number of corresponding methods have been published. Recently, for the first time, standardized PCR protocols were developed in common by 14 European centers of lymphoma diagnosis and research (Biomed-2 protocols).
View Article and Find Full Text PDFAm J Dermatopathol
February 2004
Department of Dermatology, University of Graz, Austria.
The differential diagnosis of cutaneous B-cell infiltrates with follicular pattern of growth is one of the most vexing problems in dermatopathology. In this study we focused on histopathologic, immunophenotypic, and molecular differential diagnostic criteria between Borrelia burgdorferi (Bb)-associated lymphocytoma cutis (LC), primary cutaneous follicle center cell lymphoma (FCCL), and primary cutaneous marginal zone lymphoma (MZL) with reactive germinal centers (GCs). A total of 47 patients were included in the study, including 12 cases of LC (M:F = 2:1; mean age: 38.
View Article and Find Full Text PDFBr J Dermatol
April 2002
Unit of Dermatopathology, Department of Dermatology, University of Zurich Medical School, Gloriastr. 31, CH-8091 Zurich, Switzerland.
Primary cutaneous follicular centre cell lymphoma (FCCL) is a distinct subtype of cutaneous lymphoma that originates from germinal centre cells. Histologically, the disease is typified by a bottom-heavy infiltrate with a diffuse or follicular growth pattern situated in the mid or deep dermis. In some cases, the neoplastic infiltrate may involve the underlying subcutaneous tissue, but so far primary subcutaneous FCCL has not been reported.
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