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CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 788-790 |
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| Molluscum-like lesions in a child with T cell lymphoma |
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Sarita Sanke1, Suvarna Samudrala1, Rubina Jassi1, Ram Chander1, Piali Mandal2, Anita Nangia3
1 From the Department of Dermatology, Lady Hardinge Medical College, Connaught Place, New Delhi, India
2 Department of Paediatrics, Lady Hardinge Medical College, Connaught Place, New Delhi, India
3 Department of Pathology, Lady Hardinge Medical College, Connaught Place, New Delhi, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Suvarna Samudrala
From the Department of Dermatology, Lady Hardinge Medical College, Connaught Place, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_709_22
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How to cite this article:
Sanke S, Samudrala S, Jassi R, Chander R, Mandal P, Nangia A. Molluscum-like lesions in a child with T cell lymphoma. Indian J Dermatol 2022;67:788-90 |
How to cite this URL:
Sanke S, Samudrala S, Jassi R, Chander R, Mandal P, Nangia A. Molluscum-like lesions in a child with T cell lymphoma. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 23];67:788-90. Available from: https://www.e-ijd.org/text.asp?2022/67/6/788/370342 |
Sir,
A preschool girl, with a known case of T-cell lymphoma, presented with multiple asymptomatic skin-coloured papules all over the body for 2 months. She was receiving a high dose of methotrexate intravenously for T-cell lymphoma. Examination revealed multiple discrete to grouped, umbilicated skin-coloured and haemorrhagic papules were present over the face, trunk and extremities [Figure 1]a, [Figure 1]b. Dermatoscopy showed a central haemorrhagic area with a rim of scaling, surrounding pink-white spots and a peripheral brown rim [[Figure 1]b (inset)]. Systemic examination revealed hepatosplenomegaly and generalised lymphadenopathy. Histopathological examination showed extensive infiltration of mononuclear cells in the upper dermis, with reniform nuclei and eosinophilic cytoplasm [Figure 2]a. The immunohistochemistry panel was positive for S100 and CD1a [Figure 2]b, [Figure 2]c, [Figure 2]d, confirming the diagnosis of Langerhans cell histiocytosis. | Figure 1: (a and b) Multiple discrete to grouped, umbilicated skin coloured to haemorrhagic papules over the trunk. (inset)- Central haemorrhagic area with a rim of scaling, surrounding pink-white spots and a peripheral brown rim on dermatoscopy
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 | Figure 2: (a)- Mononuclear cells showing reniform nuclei and eosinophilic cytoplasm in the upper dermis on H and E stain, and positive immunohistochemical staining for (b) S100 (c) CD1a and (d) negative for CD68
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Langerhans cell histiocytosis (LCH) is a rare disorder characterised by the clonal proliferation of Langerhans cells, expressing CD1a and S100 in one or more organs.[1],[2] It has a higher prevalence of 3 to 5 cases per million in children.[1]
LCH can be classified as localised (a single organ is affected), or multifocal multisystem (more than one organ is affected, which is more frequent in children). Skin involvement is frequent in LCH, with up to 80% of patients having multisystem involvement.[3] Though common in children, LCH involving only the skin is very rare. Cutaneous LCH classically presents as scaly and erythematous papules and plaques on the scalp and diaper areas, mimicking seborrheic dermatitis. Molluscum-like lesions in LCH have only been reported in 6 cases previously.[1],[2],[3] Our patient showed a relatively late age of onset.
Important distinctions between molluscum-like LCH and molluscum contagiosum (MC) have been described. The average age of presentation in LCH cases is 13 months, while MC commonly presents between 5 and 10 years of age, and rarely in those younger than 1 year of age, because of protective maternal antibodies. Additionally, concurrent scalp, trunk, and oral mucosal involvement may be seen in LCH. Lymphadenopathy and hepatosplenomegaly have not been reported previously in molluscum-like LCH, but systemic involvement, most commonly as osteolytic bone lesions, has been described in half the patients.[2] However, in our patient, lymphadenopathy and hepatosplenomegaly were present, while osteolytic lesions were absent.
Dermoscopic findings of LCH like red-blue lacunas, reddish-purple areas, brown dots and central white area with peripheral telangiectasia have been described.[4] To the best of our knowledge, dermoscopic findings of molluscum-like LCH lesions have not been previously described.
Very few cases of LCH associated with haematological malignancies have been reported, including classical Hodgkin lymphoma, mantle cell lymphoma and T cell lymphoma.[5] Our patient had precursor T cell lymphoma, of which only 6 cases have been previously reported.
High-risk multisystem LCH can be lethal, with a 20-50% mortality risk, despite chemotherapy. Our patient received high-dose methotrexate with minimal improvement in the lesions.
To the best of our knowledge, only 6 cases with LCH presenting as molluscum contagiosum-like lesions have been previously reported. Also, this is the first case of LCH with molluscum-like lesions in the background of T-cell lymphoma.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Armenteros JMF, Huguet NA, Novell VS, Villella FV, Sanchez AV, Català EM, et al. Langerhans cell histiocytosis mimicking molluscum contagiosum: A case series. Pediatr Blood Cancer 2018;65:e27047.  |
| 2. | Karpman MS, AlJasser MI, Lam JM. Molluscum contagiosum-like presentation of langerhans cell histiocytosis: A case and review. Pediatr Dermatol 2017;34:e288-9. |
| 3. | Huang JT, Montagos J, Kapoor R, Schmidt B, Maguiness S. Langerhans cell histiocytosis mimicking molluscum contagiosum. J Am Acad Dermatol 2012;67:e117-8. |
| 4. | Behera B, Malathi M, Thappa DM, Gochhait D, Srinivas BH, Toi PC. Dermoscopic features of three cases of Langerhans cell histiocytosis. Indian J Dermatol Venereol Leprol 2018;84:730-5. [ PUBMED] [Full text] |
| 5. | Pina-Oviedo S, Medeiros LJ, Li S, Khoury J, Patel KP, Alayed K, et al. Langerhans cell histiocytosis associated with lymphoma: An incidental finding that is not associated with BRAF or MAP2K1 mutations. Mod Pathol 2017 ;30:734-44. |
[Figure 1], [Figure 2] |
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