CD30 Tcell pseudolymphomas

In recent years, the presence of CD30+ large blasts has been observed in the skin in several reactive conditions including various viral infections (orf, milker's nodule, molluscum con-tagiosum, viral warts, herpes simplex, herpes zoster), arthropod reactions, scabies and drug eruptions (Figs 20.16-20.19) [52-56]. CD30+ cells have also been observed in lesions of hidradenitis and rhynophyma, as well as at the sites of cutaneous abscess and of injury caused by red sea coral. The finding may be related, at least in part, to improved methods

Fig. 20.16 Milker's nodule. Solitary nodule on the finger.
Fig. 20.17 Milker's nodule. Epidermal hyperplasia, large telangiectatic vessels and dense infiltrate of lymphocytes.

Siffig

Fig. 20.18 Milker's nodule. Note presence of large blastic cells (detail of Fig. 20.17).

Fig. 20.19 Milker's nodule. Positivity of the larger cells for CD30 (same case as Figs 20.17 & 20.18).

of antigen demasking and immunohistochemical staining of routinely fixed, paraffin-embedded sections of tissue (see Chapter 1).

Besides the presence of large atypical CD30+ cells, the histology in these lesions reveals the typical changes of the specific underlying disorder. Moreover, in these reactive conditions CD30+ lymphocytes are scattered throughout the infiltrate and are usually not arranged in clusters or sheets as observed in lymphomatoid papulosis or cutaneous anaplas-tic large cell lymphoma. However, in some cases differentiation may be very difficult or even impossible on histological and immunohistochemical grounds alone. Unlike the situation in lymphomatoid papulosis and cutaneous anaplastic large cell lymphoma, gene rearrangement studies in CD30+ pseudolymphomas reveal the presence of a polyclonal population of T lymphocytes.

The therapy of CD30+ pseudolymphomas depends on the specific diagnosis, and includes surgical excision, cryother-apy and antiviral treatment.

Fig. 20.20 Lupus panniculitis. Erythematous infiltrated plaque on the leg.
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