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Histopathologic Diagnosis of Lymphomatous Versus Inflammatory Erythroderma: A Morphologic and Phenotypic Study on 47 Skin Biopsies

Ram-Wolff, Caroline PhD*; Martin-Garcia, Nadine*†; Bensussan, Armand PhD; Bagot, Martine PhD‡§; Ortonne, Nicolas PhD*†

The American Journal of Dermatopathology: December 2010 - Volume 32 - Issue 8 - p 755-763
doi: 10.1097/DAD.0b013e3181cfbfbf
Original Study

Erythroderma may be secondary to a cutaneous T-cell lymphoma (CTCL) and various other erythrodermic inflammatory dermatoses (EID), and their histopathologic distinction is often difficult. The aim of this study was to determine if morphological parameters, namely: the presence of b-catenin, and JunB (previously shown to be expressed by CTCL cells), the epidermal CD8:CD3 ratio, and CD30 expression may help in the histopathologic diagnosis of erythroderma, especially in differentiating CTCL and EID. We retrospectively reviewed a series of 47 skin biopsies from patients with erythroderma (18 CTCL and 29 EID). The diagnosis of each case was established using clinical, biological and histopathologic data. After a blind assessment of the hematoxylin--eosin--safran stained slides, a correct diagnosis of the underlying cause of erythroderma was made only in 31% of cases. A correct differential diagnosis between lymphoma and EID was done with certainty in 57% of cases. Various morphologic and phenotypic parameters were then recorded and we compared their frequency in the CTCL versus the EID group. With the exception of atypical lymphocytes, the moderate to high density of dermal infiltrates and Pautrier microabcesses, only found in CTCL, no morphologic parameter was found to be specific of CTCL, although single lymphocytes epidermotropism, telangiectasias, and slight lymphocytic dermal infiltrate were significantly more frequent in EID. A low (<10%) CD8:CD3 ratio in the epidermal lymphocytic infiltrate and dermal CD30+ lymphocytes were significantly more frequent in CTCL. JunB expression by lymphocytes was specific of CTCL, but was inconstant in our series (17%). We found β-catenin expression in a minority of cases from both the CTCL and EID groups. Among EID, dermal suprapapillary thinning was specific of psoriasis. Neutrophils exocytosis and edema of papillary dermis were significantly more frequent in psoriasis, and spongiosis was more frequent in eczema. In conclusion, few morphological and phenotypical parameters are helpful in making a differential diagnosis between erythrodermic CTCL and EID using paraffin embedded skin biopsies.

From the *Département de Pathologie, Université Paris 12, Groupe hospitalier Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil Cedex, France; †INSERM U955, Hôpital Henri Mondor, Créteil, France; ‡INSERM U976, Hôpital Saint-Louis, Equerre Bazin, Paris, France; and §Service de Dermatologie, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Paris, France.

Reprints: Nicolas Ortonne, PhD, Université Paris XII, Faculté de Médecine, Hôpital Henri Mondor, AP-HP, Département de Pathologie, AP-HP, 94010 Créteil Cedex, France (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.