Diagnostic approach in lymphoplasmacytic plaque. (14th September 2015)

• Record Type: Journal Article
• Authors: Mitteldorf, C.; Palmedo, G.; Kutzner, H.; Kauer, F.; Prestin, M.; Schuster, C.; Hübscher, E.; Kirsch, A.; Tronnier, M.; Kempf, W.
• Is Part Of: Journal of the European Academy of Dermatology and Venereology. Volume 29:Number 11(2015:Nov.)
• Page Start: 2206
• Page End: 2215
• Publication Date: 2015-09-14
• Subjects: Dermatology -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.5
• DOI: 10.1111/jdv.13213
• Languages: English
• ISSNs: 0926-9959

Abstract

<abstract abstract-type="main" id="jdv13213-abs-0001"> <title>Abstract</title> <sec id="jdv13213-sec-0001" sec-type="section"> <title>Background</title> <p>Lymphoplasmacytic plaque (LPP) is a recently described rare skin disease characterized by a dense dermal lymphohistiocytic infiltrate with polyclonal plasma cells. The clinical picture is distinct with reddish to brownish plaque with a predilection for the lower leg. LPP typically affects children.</p> </sec> <sec id="jdv13213-sec-0002" sec-type="section"> <title>Objective</title> <p>To define clinical and histologic criteria of LPP and to develop a diagnostic flow chart.</p> </sec> <sec id="jdv13213-sec-0003" sec-type="section"> <title>Methods</title> <p>We investigated six of our own LPP cases. Immunoglobulin light chains, IgG, IgG4, CD31, CD163 as a histiocytic marker were examined by immunohistochemistry. PCR‐based molecular studies were conducted for borrelia sp., mycobacterial and leishmania sp. Moreover, 10 cases, which have been reported in the literature, were checked for the same features.</p> </sec> <sec id="jdv13213-sec-0004" sec-type="section"> <title>Results</title> <p>We could differentiate three main histological patterns (superficial band‐like only, [deep] dermal only and mixed). Acanthosis and interface dermatitis are key features in cases with a superficial band‐like or mixed infiltrate. Granulomas and giant cells could be only found in about 30% of the cases. The number of plasma cells was variable accounting for 5–40% of the infiltrate. The number of blood vessels was increased in the majority of the cases. 'Free‐floating' collagen bundles surrounded by histiocytes (pseudorosettes) were identified as a new histological feature. An infectious agent could be excluded in all cases.</p> </sec> <sec id="jdv13213-sec-0005" sec-type="section"> <title>Conclusions</title> <p>LPP is a long‐standing skin disease, which may also occur in adults and in other body regions than the lower leg. Reproducible clinical and histological criteria allow delineating a diagnostic work‐up for LPP.</p> </sec> </abstract>