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

Due to the clinical suspicion of lymphoma, the patient underwent
18
F‑FDG PET/CT (18F‑FDG was produced by the Eclipse RD
cyclotron, Siemens Medical Solutions USA, Inc., USA; and PET/
CT scanner was also from the Siemens Medical Solutions USA,
Inc.), and results showed numerous enlarged lymph nodes with FDG
avidity in bilateral cervical, supraclavicular, axillary, mediastinal,
retroperitoneal, pelvic, and inguinal regions [Figure 1]. Left cervical
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
S100 [Figure 2c and d]. The patient was subsequently diagnosed
as DL by pathology examination and was treated with kitasamycin
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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lymphadenitis. (a) Maximum intensity projection positron emission
tomography image shows extensive 18F‑fluorodeoxyglucose‑avid
lymphadenopathy in bilateral cervical, supraclavicular, axillary,
mediastinal, retroperitoneal, pelvic, and inguinal regions. (b‑d) Transaxial
positron emission tomography/computed tomography fusion images
show enlarged cervical, axillary, and inguinal lymph nodes. The largest
lymph node measures 24 mm × 12 mm in the right axilla, with
maximum standardized uptake value of 12.2.
Address for correspondence: Dr. Yun‑Hua Wang,
PET/CT Center of The Second Xiangya Hospital, Central South University,
Changsha, Hunan 410011, China
E‑Mail: 13973186448@139.com
This is an open access article distributed under the terms of the Creative Commons
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© 2015 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow

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

a b
c d
Figure 2: Histological images of the left neck lymph node of the patient
with dermatopathic lymphadenitis. (a and b) lymphoid hyperplasia and
structural disorder, paracortical enlargement by T‑zone proliferation with
pigment laden histiocytes (H and E, original magnification a, original
magnification, ×100; b, original magnification, ×200). (c and d)
Immunohistochemical staining shows positive cytoplasmic staining
for CD68 and S100, respectively (original magnification, ×100).
Diagnosis of DL is mostly based on the lymph node biopsy. In
this case, the short axis of the biopsied lymph node exceeded
2 cm in 18F‑FDG PET/CT. It is well‑known that atypical lymphoid
hyperplasia could mimic lymphoma in the clinical hematology
practice[5] and it is sometimes difficult to distinguish between
lymphoma and DL with PET/CT examination. However, PET/CT
3122 Chinese Medical Journal ¦ November 20, 2015 ¦ Volume 128 ¦ Issue 22
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
employed as a valuable aid in the diagnostic workup.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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