T-cell-predominant lymphoid hyperplasia in a tattoo.
Bottom Line: We present a case of a predominantly T CLH, secondary to the black pigment of tattooing in a 35-year-old patient, with a dense infiltrate of small, medium and scarce large T-cells.Analysis of the rearrangement of T-cells receptor revealed a polyclonal proliferation.Since the infiltrate of CLH can simulate a T lymphoma, it is important to show that lesions from tattoos can have a predominance of T-cells.
Cutaneous lymphoid hyperplasia (CLH) can be idiopathic or secondary to external stimuli, and is considered rare in tattoos. The infiltrate can be predominantly of B or T-cells, the latter being seldom reported in tattoos. We present a case of a predominantly T CLH, secondary to the black pigment of tattooing in a 35-year-old patient, with a dense infiltrate of small, medium and scarce large T-cells. Analysis of the rearrangement of T-cells receptor revealed a polyclonal proliferation. Since the infiltrate of CLH can simulate a T lymphoma, it is important to show that lesions from tattoos can have a predominance of T-cells.
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Mentions: A 35-year-old woman presented with a history of pruritic lesions over a tattoo. The tattoowas done about five years ago and the lesion appeared four and a half years later. Shereferred prolonged sun exposure on weekends. Physical examination revealed abutterfly-shaped tattoo with red, black and yellow pigments in the interscapular region.There was a linear, erythematous, scaly plaque on one of the tattoo edges, corresponding tothe red and black pigments (Figure 1 A). Histologicalexamination showed epidermis with acanthosis, parakeratosis and foci of spongiosis and mildepidermotropism. In the upper and mid dermis, there was a dense infiltrate of small, mediumand rare large lymphocytes, with irregular contours and some histiocytes and plasma cells(Figure 2A and 2B). The same infiltrate was present deeper around vessels and adnexae, andbetween collagen fibers (Figure 2C). Macrophages withblack pigment, and less frequently with red pigment, were observed amidst the infiltrate.The black pigment was also seen in the interstitium. T-cells, UCHL-1+, CD2+, CD3+, and CD4+represented around 90% of the infiltrate, with some CD20+ lymphocytes, a small number ofCD79a+ plasma cells and CD68+ histiocytes (Figure2D). CD1a was focally positive. Proliferative index evaluated by Ki-67 was around10%. Analysis of the rearrangement of the genes that codify the T-cell receptors in theskin lesion was performed according to a previously established method, and a polyclonalexpansion of the T lymphocytes was observed.3