Wang 2015

Correspondence
Dermatopathic Lymphadenitis
Na Hu1, Yan‑Lin Tan1, Zhen Cheng2, Yun‑Hua Wang1
PET/CT Center of The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
1
2
Department of Radiology and Bio‑X Program, Canary Center at Stanford for Cancer Early Detection, Stanford University, Stanford, California, CA 94305, USA
To the Editor: Dermatopathic lymphadenitis (DL) represents a DL, also known as lipomelanotic reticulosis or Pautrier‑Woringer
rare benign lymphatic hyperplasia commonly associated with disease, represents a rare form of benign lymphatic hyperplasia
exfoliative or eczematoid dermatitis. DL was also reported to associated with most exfoliative or eczematoid inflammatory
be a potential mimicker of lymphoma.[1] Here, we report the erythrodermas, including pemphigus, psoriasis, eczema,
18
F‑fluorodeoxyglucose (18F‑FDG) positron emission tomography/ neurodermatitis, and atrophia senilis.[2,3] Painless lymphadenopathy
computer tomography (PET/CT) results and the histological accompanied by fever is the most common presentation. It is a
findings of a 40‑year‑old female patient with DL. self‑limited disease often not requiring any therapy.[4]
A 40‑year‑old female with a history of chronic vitiligo and urticaria
was admitted to our hospital because of worsening recurrent fever
and chronic joint pain for more than 2 years. She reported that her
symptoms had aggravated in the month prior to her presentation.
Her body temperature was 39.3°C at the time of admission. Physical
examination revealed scattered nonblanchable erythematous
papules coalescing into plaques, most prominently in the upper chest
and bilateral upper extremities. Generalized lymphadenopathy was
noted, with the largest lymph node measuring up to 3 cm in short b
axis found in the axilla. The lymph nodes were firm, nontender, and
mobile. Laboratory tests revealed the following: White blood cell a
count of 16,000 cells/mm3 (normal range: 4000–10,000 cells/mm3),
C‑reactive protein of 106 mg/L (normal range: 0–8 mg/L),
erythrocyte sedimentation rate of 140 mm/h (normal range:
1–20 mm/h), ferritin of 7789.47 ng/ml (normal range:
4.63–204.00 ng/ml), immunoglobulin E of 1113 ng/ml
(normal range: 0–619.40 ng/ml), and lactate dehydrogenase of c d
371.6 U/L (normal range: 109.0–245.0 U/L). Bone marrow biopsy
demonstrated bone marrow hyperplasia with significantly increased Figure 1: F‑fluorodeoxyglucose positron emission tomography/
18
megakaryocyte distribution. computed tomography images of the patient with dermatopathic

lymphadenitis. (a) Maximum intensity projection positron emission
Due to the clinical suspicion of lymphoma, the patient underwent tomography image shows extensive 18F‑fluorodeoxyglucose‑avid
18
F‑FDG PET/CT (18F‑FDG was produced by the Eclipse RD lymphadenopathy in bilateral cervical, supraclavicular, axillary,
cyclotron, Siemens Medical Solutions USA, Inc., USA; and PET/ mediastinal, retroperitoneal, pelvic, and inguinal regions. (b‑d) Transaxial
CT scanner was also from the Siemens Medical Solutions USA, positron emission tomography/computed tomography fusion images
Inc.), and results showed numerous enlarged lymph nodes with FDG show enlarged cervical, axillary, and inguinal lymph nodes. The largest
avidity in bilateral cervical, supraclavicular, axillary, mediastinal, lymph node measures 24 mm × 12 mm in the right axilla, with
retroperitoneal, pelvic, and inguinal regions [Figure 1]. Left cervical maximum standardized uptake value of 12.2.
lymph node biopsy was performed and pathology revealed lymphoid
hyperplasia along with normal lymphoid tissue [Figure 2a and
b]. Immunohistochemical analysis showed positive CD68 and Address for correspondence: Dr. Yun‑Hua Wang,
S100 [Figure 2c and d]. The patient was subsequently diagnosed PET/CT Center of The Second Xiangya Hospital, Central South University,
Changsha, Hunan 410011, China
as DL by pathology examination and was treated with kitasamycin
E‑Mail: 13973186448@139.com
and supportive measures. Her fever resolved and skin symptoms
were diminished obviously. At follow‑up, one and a half year after
her presentation, she remained symptom‑free.
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DOI: Received: 27‑07‑2015 Edited by: Qiang Shi

10.4103/0366-6999.169172 How to cite this article: Hu N, Tan YL, Cheng Z, Wang YH.
Dermatopathic Lymphadenitis. Chin Med J 2015;128:3121-2.
Chinese Medical Journal ¦ November 20, 2015 ¦ Volume 128 ¦ Issue 22 3121
can still demonstrate most or all of the involved lymph nodes
and provide information about their size, number, distribution,
and FDG avidity, which can serve as a valuable guide to lymph
node biopsy.
In conclusion, although diagnosis of DL mainly depends on the
clinical presentation and lymph node biopsy, 18F‑FDG PET/CT, as
a sensitive and noninvasive whole‑body imaging technique, can be
a b employed as a valuable aid in the diagnostic workup.
Financial support and sponsorship

Nil.
Conflicts of interest
There are no conflicts of interest.
c d
References
Figure 2: Histological images of the left neck lymph node of the patient 1. Makis W, Hickeson M, Blumenkrantz M. Interesting image.
with dermatopathic lymphadenitis. (a and b) lymphoid hyperplasia and Dermatopathic lymphadenitis: A pitfall for lymphoma evaluation by
structural disorder, paracortical enlargement by T‑zone proliferation with F‑18 FDG PET/CT. Clin Nucl Med 2010;35:872‑4.
pigment laden histiocytes (H and E, original magnification a, original 2. Acipayam C, Kupeli S, Sezgin G, Acikalin A, Ozkan A, Inan DA,
magnification, ×100; b, original magnification, ×200). (c and d) et al. Dermatopathic lymphadenitis associated with human papilloma
Immunohistochemical staining shows positive cytoplasmic staining virus infection and verruca vulgaris. J Pediatr Hematol Oncol
for CD68 and S100, respectively (original magnification, ×100). 2014;36:e231‑3.
3. Steffen C. Frédéric Woringer: Pautrier‑Woringer disease
(lipomelanotic reticulosis/dermatopathic lymphadenitis). Am J
Diagnosis of DL is mostly based on the lymph node biopsy. In Dermatopathol 2004;26:499‑503.
this case, the short axis of the biopsied lymph node exceeded 4. Psarommatis I, Vontas H, Gkoulioni V, Mihail‑Strantzia A,
2 cm in 18F‑FDG PET/CT. It is well‑known that atypical lymphoid Bairamis T. Dermatopathic lymphadenitis imitating a deep neck
hyperplasia could mimic lymphoma in the clinical hematology space infection. Am J Otolaryngol 2009;30:419‑22.
practice[5] and it is sometimes difficult to distinguish between 5. Good DJ, Gascoyne RD. Atypical lymphoid hyperplasia mimicking
lymphoma and DL with PET/CT examination. However, PET/CT lymphoma. Hematol Oncol Clin North Am 2009;23:729‑45.
3122 Chinese Medical Journal ¦ November 20, 2015 ¦ Volume 128 ¦ Issue 22

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Correspondence

megakaryocyte distribution. computed tomography images of the patient with dermatopathic

DOI: Received: 27‑07‑2015 Edited by: Qiang Shi

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