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Pseudolymphom

Zuletzt geändert von Thomas Brinkmeier am 2025/04/25 21:40

Pseudolymphom

Def: relativ häufige benigne lymphoproliferative Infiltrate der Haut, die klinisch und histologisch einem kutanen Lymphom ähneln können

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Etlg: - follikuläre B-Zell-Pseudolymphome

Pa: Ausbildung von Keimzentren

Bsp: Lymphadenosis cutis benigna (Borreliose)

- nichtfollikuläre B-Zell-Pseudolymphome

Pa: keine Keimzentren

Bsp: Insektenstichreaktion (persistierend)

- noduläre T-Zell-Pseudolymphome

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Pa: T-zelluläre Infiltrate überwiegen

Bsp: lymphozytische Infiltration Jessner-Kanof

So: - pseudolymphomatöse Tätowierungsreaktion

Engl: pseudolymphomatous tattoo reaction

TF: meist rotes Tätowierungspigment

Hi: 

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KL: 

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Lit: Case Rep Dermatol. 2018 Jun 14;10(2):162-168. http://doi.org/10.1159/000489875

- pseudolymphomatöse Follikulitis

Lit: Acta Derm Venereol. 2024 Sep 18;104:adv41199. http://doi.org/10.2340/actadv.v104.41199

Lit:  

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DD: B-Zell-Pseudolymphom vs. B-Zell-Lymphom

- B-Zell-Pseudolymphom

Vork: Kinder und Erwachsene

Ät: Infekte (Borrelien), Insektenstiche

HV: meist solitär

Hi: - symmetrische Architektur mit rel. scharfer Begrenzung

- höchste Infiltratdichte im Korium ("top heavy") ohne periadnexielle Betonung

- häufige Ausbildung von Keimzentrum mit breitem Randwall

- polymorphes Infiltrat

- rel. häufig Eosinophile

- hohe Vaskularisation

- keine nekrotischen Bezirke

IHC: - keine monoklonale Leichtkettenrestriktion

- hoher Nachweis der Proliferationsmarker Ki67/MIB-1

PCR: - kein TCR-Rearrangement

- B-Zell-Lymphom

Vork: Erwachsene

Ät: unbekannt

HV: meist multipel

Hi: - asymmetrische Architektur mit rel. unscharfer Begrenzung

- höchste Infiltratdichte tief dermal ("bottom heavy") mit periadnexieller Betonung

- seltene Ausbildung von Keimzentren mit dünnem Randwall

- monomorphes Infiltrat

- selten Eosinophile

- normale Vaskularisation

- ggf. nekrotische Areale

IHC: - monoklonale Leichtkettenrestriktion

- reduzierter Nachweis der Proliferationsmarker Ki67/MIB-1

PCR: TCR-Rearrangement

So: pseudolymphomatoide Follikulitis

Engl: pseudolymphomatous folliculitis

Lit: Dermatol Online J. 2020 May 15;26(5):13030/qt85t3f8nw

Th: - Ausschalten potentieller Trigger

Bsp: Medikation umsetzen

- Glukokortikoide (topisch, intraläsional oder oral)

- Antibiotika (insbes. Doxycyclin)

- Imiquimod 5% Creme

Lit: Acta Derm Venereol. 2013 Nov 8. http://doi.org/10.2340/00015555-1730 (Dänemark)

- Interferon alpha-1b intraläsional

Lit: Dermatol Ther. 2020 Apr 16:e13410. http://doi.org/10.1111/dth.13410

Co: Betamethason

- UV-Therapie (z. B. PUVA, SUP)

- Photodynamische Therapie (PDT)

Lit: G Ital Dermatol Venereol. 2020 Feb 5. http://doi.org/10.23736/S0392-0488.19.06337-5

- Radiatio

Meth: v. a. schnelle Elektronen

Bed: Ultima Ratio

  
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