CUTANEOUS HODGKINS-DISEASE - AN IMMUNOHISTOCHEMICAL ANALYSIS

Studies of skin involvement in Hodgkin's disease are infrequent in the literature. In particular, immunophenotypic analyses of specific cutaneous infiltrates have been performed in only a few cases. We analyzed the clinical, histological and immunohistochemical features of specific cutaneous manifestations of Hodgkin's disease comparing histologic and immunophenotypic aspects of skin lesions with those of the nodal counterpart. Seven patients with Hodgkin's disease of the lymph nodes and specific cutaneous lesions, where both nodal and skin biopsies were available for histologic and immunohistochemical analyses, were included in this study. Immunohistochemical stains were performed with a 3-step immunoperoxidase technique on routinely-fixed, paraffin-embedded tissue sections. All 7 patients had nodular sclerosis Hodgkin's disease of the lymph nodes. In the skin, clinical presentations included reddish-brown papules, plaques, nodules and ulcerated tumors. Histologic examination of cutaneous lesions showed features consistent with nodular sclerosis Hodgkin's disease in 6 cases and unclassifiable Hodgkin's disease in one. Reed-Sternberg cells and lacunar cells were present in 4 cases (57.1%). Immunohistochemical analysis of Hodgkin's and Reed-Sternberg cells revealed a constant positivity for CD30 (BerH2) and negativity for CD45 (LCA) in both the lymph nodes and the skin. Staining with CD15 (Mi) revealed positivity in 7/7 nodal samples and 5/7 skin biopsies. Cytoplasmic expression of immunoglobulin light chains (both lambda and kappa) was observed in one cutaneous case. The accompanying infiltrate was mostly composed of T-lymphocytes admixed with variable numbers of monocytes/macrophages and eosinophils. Our results indicate that the histology of cutaneous specific manifestations of Hodgkin's disease correlates with that of the nodal counterpart in most cases. Classical Reed-Sternberg cells, however, can be detected only in a proportion of the cutaneous lesions. Although the immunophenotype of Hodgkin cells and Reed-Sternberg cells in the lymph nodes and the skin is similar, CD15-negativity of Reed-Sternberg cells can be observed in cutaneous infiltrates of Hogkin's disease.