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In an ultrastructural study supplementing previous histological, cytochemical and immunocytological investigations of lymphadenosis benigna cutis, the tumor is shown to consist mainly of two cell types: Lymphocytes and macrophagocytic (reticulum?) cells. The tendency to spontaneous regression is manifested on the ultrastructural level by pronounced degenerative alterations.
Swelling and erythema of the right pinna developed in a 7-year-old girl. Six months later a biopsy specimen showed a dense, diffuse lymphoplasmacytic infiltrate involving most of the dermis except for a thin Grenz zone. The appearance was consistent with lymphocytoma cutis. She had been bitten by a tick on the right ear in Switzerland 6 weeks before the onset of the lesion. Serologic tests by enzyme-linked immunosorbent assay for Borrelia burgdorferi, done 6 and 11 months after the bite, yielded optical density readings of 1.04 and 0.65, respectively; indirect immunofluorescence yielded titers of 1:256 and 1:128. A Borrelia-like organism was identified by a modified Steiner stain; immunohistochemistry was noncontributory. The spirochetal origin of lymphadenosis benigna cutis is briefly reviewed.
We report the development of a lymphoproliferative reaction in the red areas of a tattoo in a 53-year-old man. The results of histologic and immunohistochemical studies were consistent with a diagnosis of lymphadenosis benigna cutis. Patch tests showed a strong, delayed-type hypersensitivity to several mercury products. The pathogenetic mechanisms operative in the development of this reaction are discussed.
We report a 38-year-old woman who developed an erythematous nodule on her earlobe after wearing pierced-type 18-carat gold earrings. Biopsy specimens revealed dense cellular infiltration predominantly composed of lymphocytes and plasma cells in the dermis and subcutaneous tissue with formation of lymph follicles. Morphological and immunohistochemical analyses were compatible with lymphadenosis benigna cutis.
BACKGROUND: Photodynamic therapy (PDT) using topical delta-aminolevulinic acid (ALA) has been used for nonmelanoma skin cancers, including malignant cutaneous T-cell lymphomas. Moreover, PDT has been tried for benign inflammatory or infectious skin lesions. OBJECTIVE: To evaluate the effects of ALA-PDT on skin lesions of lymphadenosis benigna cutis (LABC). PATIENTS AND METHODS: Two 16-year-old females with solitary and infiltrated nodules were treated 5 times with topical ALA-PDT. RESULTS: Both patients responded well and showed dramatic clinical and histopathological improvement without visible scars. CONCLUSION: The results confirm that topical ALA-PDT is an effective and safe modality for the treatment of LABC, and that such treatment may be cosmetically beneficial.
We report three cases of lymphadenosis benigna cutis in children. The lesions were situated on the earlobe and the nipple. The diagnosis was verified by determination of Borrelia antibodies in serum and a positive response to oral penicillin treatment.
This report deals with the case of a 50 year-old woman with long-standing scleroderma of the acral-asphyxial type with a relatively slight tendency to progression. Chronic lymphadenosis has been an additional feature of this case over the past few years. The following findings appear of particular interest: autoimmune phenomena in the form of antinuclear antibodies, a virtually monoclonal proliferation of B-lymphocytes and a relative T-lymphocyte deficiency. It is suggested that both conditions may be pathogenetically connected with an immunologically defined insufficiency of the lymphocytic system. Hence, in view of this observation, it may not be correct to consider scleroderma a "paraneoplastic phenomenon".
In 8 patients with lymphadenosis benigna cutis (LABC) cytochemical and in 2 of them immunocytological studies have been performed. 1) In patients with LABC we find ectopic organoid proliferations of "lymphfollicle"-like structures within the dermis which predominately consist of small lymphocytes and large reticulum cells. Immunocytological differentiation of the lymphocytes leads to the characterization of B- and T-lymphocytes in a ration 2:1. 2) Large reticulum cells represent a peculiarly remarkable cell class in infiltrates of LABC. Because of their typical arrangement disseminated within the lymphocytic infiltrate they have been designated as "starry sky" cells. Cytochemically they are characterized by an unusual high content of nonspecific esterases and acid phosphatase, most of them show phagocytized basophilic bodies. Because of their shape, arrangement and enzymcytochemical behaviour these cells can be referred to as typical for the LABC disease. 3) Monocytes cannot be found within the "lymphfollicles". Mast cells and connective tissue cells are rarely observed. Polymorphonuclear granulocytes can be demonstrated in great numbers in any part of the involved cutis when there is an insect bite in history. 4) As a reaction of the ectopic proliferation of lymphoreticular tissue within the dermis there is an activation of the surrounding connective tissue with an increase of the alkaline phosphatase activity within these cells, new formation of collagen fibres and strong proliferation of alkaline phosphatase positive capillaries. 5) Etiopathologically it is stressed, that in LABC for example an insect bite induces stimulation of hematopoietic potentialities of undifferentiated mesenchymal germ centres within the cutis takes place, leading to the development of ectopic of "lymphfollicle" like structures.
Fiftyone patients with a diagnosis of erythema chronicum migrans (ECM), lymphadenosis cutis benigna (LABC), systemic progressive sclerosis, localized scleroderma and lichen sclerosus et atrophicans were investigated in order to obtain serological evaluation of Borrelia burgdorferi circulating antibodies. In addition sera from 9 patients with pellagroid erythema, prurigo and panniculitis were performed: in these dermatoses there was no evidence of a possible borrelia relationship. Indirect immunofluorescence assay was used for serologic testing. Elevated IgG antibody titers were detected in one female patient with localized scleroderma (1:128) and in one male patient with LABC (1:64). Serologic testing was not positive in the other 58 patients. The very small number of patients with positive antibodies in our study would indicate that Borrelia burgdorferi infection is sporadic in Lazio.
Ten patients with a clinical diagnosis of lymphadenosis benigna cutis (LABC) solitaria were investigated. Four of the patients knew that they had received a tick bite during the year prior to the appearance of the LABC lesion. Five patients had had a migrating erythema, indicating a previous erythema chronicum migrans Afzelius, near the site where the LABC lesion had developed. In one patient meningitis and a facial palsy occurred. Elevated titers of antibodies against Borrelia spirochetes were found in sera from six of nine patients. Spirochetes were cultivated from one out of two biopsies from LABC lesions. The clinical findings, the results of the serologic tests and the successful cultivation of spirochetes show that Ixodes ricinus-transmitted Borrelia spirochetes can cause LABC solitaria.
Forms of lymphadenosis benigna cutis (Lbc) which run an unusual course may present considerable problems and are sometimes difficult to distinguish from malignant lymphomas of the skin on the basis of the clinical and histological picture. The case of a female patient is reported, who presented with plaque-like infiltrative lesions on both lower arms. The lesions were interpreted as being malignant lymphomas of the skin. After a progressive course of 6 years' duration, the diagnosis of an unusual plaque-like infiltrative form of Lbc caused by Borrelia was serologically confirmed by the demonstration of anti-Borrelia burgdorferi antibodies. Immunohistochemical examinations yielded the picture of a follicular pseudolymphoma with the formation of germ centres. After several weeks of penicillin therapy the skin lesions cleared completely.
It is reported on a 79-year-old female patient who died from coma hepaticum. As evoking cause an immunesuppressive treatment with cyclophosphamide or prednisolone, respectively, on account of chronic lymphadenosis with excessive thrombocytopenia is discussed. An accessible preliminary lesion of the liver after an infectious jaundice with persistence of the HBs-antigen from which the patient formerly suffered is probable. It is referred to the combination of the chronic aggressive hepatitis with malignant systemic diseases and immunopathy, taking into consideration the decision of therapy.
Seven cases of acrodermatitis chronica atrophicans (ACA), 11 cases erythema chronicum migrans (EMC) and 3 cases of lymphadenosis benigna cutis (LABC) have been analysed. In Warthin-Starry stained sections, spirochetal structures were present in all cases. The spirochetes were mesodermotropic and irregularly distributed.
Problems of diagnosis and therapy of chronic lymphadenosis are demonstrated together with historical facts of haematology. Questions of actual research (leukaemic disposition, antigen interaction, unclassified forms) are referred as well as of individual factors of the treatment of patients with chronic lymphocytic leukaemia.
Lymphadenosis NK/LY resistant to rubomycin was obtained on its repeated cultivation in mice treated with the antibiotic. The rubomycin resistance was stable and preserved for a long period of time when the line was repeatedly cultivated in mice not exposed to the antibiotic. The tumor cells resistant to rubomycin acquired resistance to olivomycin. DNA histograms of the tumor cells obtained by means of impulse cytophotometry provided determination of the tumor sensitivity and resistance to antitumor agents. It is recommended that impulse cytophotometry be used for the screening of antitumor drugs and development of their administration regimen.
The authors draw attention to the leukostasis syndrome which develops in haematological patients in case of enormous leucocyte proliferation. It occurs most frequently in chronic myelosis but may occur also in other types of leukaemia. The diagnosis is not easy. Most frequently disorders of the microcirculation develop in the lungs and brain. These are frequently very urgent clinical situations which can be resolved by leukapheresis. The authors described a patient where during chronic lymphadenosis proliferation of lymphocytes occurred to values of 1432 x 10(9)/l. After leukapheresis and cytostatic treatment rapid improvement of the condition occurred and the leucocyte values were approximately 30 x 10(9)/l. The patient's condition improved for a long period of time and became stabilized.
The second communication of our experiences with extracorporeal blood irradiation comprises a systematical investigation of the conditions in blood picture and, in one case, of the morphological findings within lymph node punctures, during long-term treatment of two selected patients with a rather different course of the disease. One of the cases showed a typical pattern of chronic lymphadenosis which was to be influenced fairly well; the other case revealed an aggressive tendency with only a feeble response to extracorporeal blood irradiation. By means of toluidine blue staining, until now being used for the verification of nucleoli and their different shapes only in experimentations on animals, a good correlation of the nucleole analysis in the peripheral blood picture and in the lymph node biopsies with the clinical progress of the disease has been observed. Thus, this simple cytological method combined with customary clinical examinations may serve as a criterion for the judgement on the course of the disease and on the therapeutic success.
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