Indian Journal of Dermatology
IJDŽ QUIZ
Year
: 2014  |  Volume : 59  |  Issue : 1  |  Page : 103--104

Multiple erythematous shiny papules and nodules over scrotal skin


Rajesh Kumar Mandal1, Sabyasachi Banerjee1, Sudip Kumar Ghosh2, Piyush Kumar3,  
1 Department of Dermatology, Venereology, and Leprosy, North Bengal Medical College, Darjeeling, India
2 Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, India
3 Department of Dermatology, Venereology, and Leprosy, Katihar Medical College, Katihar, Bihar, India

Correspondence Address:




How to cite this article:
Mandal RK, Banerjee S, Ghosh SK, Kumar P. Multiple erythematous shiny papules and nodules over scrotal skin.Indian J Dermatol 2014;59:103-104


How to cite this URL:
Mandal RK, Banerjee S, Ghosh SK, Kumar P. Multiple erythematous shiny papules and nodules over scrotal skin. Indian J Dermatol [serial online] 2014 [cited 2020 Aug 13 ];59:103-104
Available from: http://www.e-ijd.org/text.asp?2014/59/1/103/123533


Full Text

A 38-year-old man presented with multiple erythematous smooth-surfaced shiny papules and nodules over the scrotal skin for the preceding one year. The lesions had insidious onset and were asymptomatic. They slowly increased in size and number to the present situation. There was no history of drug intake, insect bite, tattooing, scabies, vaccination, or acupuncture prior to onset of the lesions. Rest of the history was unremarkable and no other family member had similar lesions. On examination, multiple firm, dome-shaped papules and nodules of varying size were noted on the scrotum. The surface was smooth and shiny, devoid of any scaling or prominent follicular opening [Figure 1]. No regional lymphadenopathy was noted. A 4 mm punch biopsy from the nodule was made. The histopathological features (H and E stain) were shown in [Figure 2] and [Figure 3].{Figure 1}{Figure 2}{Figure 3}

 Question



What is the diagnosis?

 View AnswerAnswer

Cutaneous lymphoid hyperplasia (CLH)

Histopathological findings

There was no significant change in the epidermis. The basal layer was intact and there was a narrow grenz zone. The dermis predominantly showed diffuse infiltrates comprised of lymphocytes admixed with variable number of histiocytes, eosinophils, and plasma cells. The infiltrate tends to be denser in the upper dermis. No cellular atypia, mitotic figures, or cellular pleomorphism was found.

 Discussion



CLH or cutaneous pseudo lymphoma is a term used to describe non malignant skin lesions that bear clinical and/or histological resemblance to lymphoma. CLH is characterized by a relatively dense lymphoid infiltrate, and is usually rich in B cells. CLH is also known as Lymphocytoma cutis, Spiegler-Fendtsarcoid, Lymphadenitisbeningna cutis, and Bafverstedt syndrome. [1] Etiopathogenesis of CLH remains elusive. However, in most of the cases, several associations of CLH have been described. The important association may include arthropod bites, post-zoster, tattoos, acupuncture, vaccination, trauma, medications, and infections like Borrelia burgdorferi and Leishmania donovani among others. [2] CLH mostly involves the head, neck, extremities, chest, and genitalia. Lesions are solitary or multiple, red to violaceous doughy nodules. Lesions secondary to arthropod bite are pruritic, crusted, and ulcerated. The clinical differential diagnoses include scabetic nodule, Jessener's lymphocytic infiltration of skin, granuloma annulare, Hansen's infection, metastatic nodule, scrotal steatocystoma, and cutaneous B-cell lymphoma. We ruled out scabetic nodule as there was no history of itching and clinically the nodules were smooth-surfaced with no excoriation marks. Moreover, no evidence of scabies was found elsewhere in the body. On histopathological examination, CLH usually shows nodular or diffuse lymphocytic infiltrate concentrated in the dermis with a "top-heavy" appearance. In most cases epidermis is unremarkable and separated from the underlying infiltrate by a narrow grenz zone. [3] Well-defined lymphoid follicles may be seen in a few cases. Histopathologically, CLH needs to be differentiated from B-cell lymphoma, which shows monomorphic, "bottom-heavy" distributions of cells, cellular atypia, destructive growth affecting the adnexa, thinned or absent mantle zone, and mitotic activity in both within and outside germinal centers.

Various treatment modalities of LCH may include topical and intralesional glucocorticoids, surgical excision, cryotherapy, cytotoxic agents, interferons, and antimalarials. However, the response to treatment is variable.

The names of the winners(first three correct entries) are:

Geeti Khullar, PGIMER Chandigarh Laxmisha Chandrasekhar, JIPMER PuduchheryHimanshu Gupta, ESIC-PGIMSR, New Delhi

"Others who have sent correct answers are mentioned below:"

Vinay Keshavmurthy, Urmi Khanna, Vishal Chugh, Tirthankar Gayen, Aniket B. Bhole, Nirmal.B, Mrinal Gupta, Suneil Pravin Gandhi, Meghana Phiske, S. Murugan, Anjali Pal, Hari Kishan Kumar.Y, Shreyans mutha, Neetu Bhari, Dipti Das, Mugdha Jhamwar, Aancha Panth, Sonia Mangal, Priyanka C. Patil

References

1Ploysangam T, Breneman DL, Mutasim DF. Cutaneous pseudolymphomas. J Am Acad Dermatol 1998;38:877-95; quiz 896-7.
2Lackey JN, Xia Y, Cho S, Sperling LC. Cutaneous lymphoid hyperplasia: A case report and brief review of the literature. Cutis 2007;79:445-8.
3Nihal M, Mikkola D, Horvath N, Gilliam AC, Stevens SR, Spiro TP, et al. Cutaneous lymphoid hyperplasia: Alymphoproliferative continuum with lymphomatous potential. Hum Pathol 2003;34:617-22.