Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 302-304
Regional lymphomatoid papulosis arising after total mastectomy for breast cancer


Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Date of Web Publication22-Sep-2022

Correspondence Address:
Ji-Hye Park
Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_993_21

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How to cite this article:
Bae JH, Jung YJ, Oh SJ, Lee JH, Lee DY, Lee JH, Park JH. Regional lymphomatoid papulosis arising after total mastectomy for breast cancer. Indian J Dermatol 2022;67:302-4

How to cite this URL:
Bae JH, Jung YJ, Oh SJ, Lee JH, Lee DY, Lee JH, Park JH. Regional lymphomatoid papulosis arising after total mastectomy for breast cancer. Indian J Dermatol [serial online] 2022 [cited 2022 Oct 6];67:302-4. Available from: https://www.e-ijd.org/text.asp?2022/67/3/302/356779




Sir,

If any skin lesion occurs at the previous breast cancer site, biopsy should be performed under suspicion of recurred breast cancer or skin metastasis. However, a second malignancy such as skin cancer, Paget's disease, or lymphoma can also be diagnosed.

A 52-year-old woman presented with a 1-month history of erythematous papules on her right breast, right axillary area, and right upper arm [Figure 1]. The overall number of skin lesions gradually increased over time, although some lesions resolved. The patient had been diagnosed with right breast cancer 6 months prior. Total mastectomy with axillary lymph node dissection and without breast re-construction was performed after neoadjuvant chemotherapy. The patient received adjuvant radiotherapy at the right side of the chest and adjuvant chemotherapy.
Figure 1: (a) Erythematous papules on the right chest. (b) Erythematous papules on the right axillae area and upper arm

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Punch biopsy showed a wedge-shaped dermal infiltrate composed of large lymphocytes with hyper-chromatic nuclei [Figure 2]a, [Figure 2]b. The immunohistochemical studies showed that the atypical lymphocytes were positive for CD30 [Figure 2]c. The level of CD4 expression was predominant compared to that of CD8 [Figure 2]d. The clinical and pathologic findings were consistent with lymphomatoid papulosis, type C. After 1 month of topical steroid application, the palpable lesions resolved, and only mild erythema and pigmentation remained. At the 6-month follow-up, the patient was free of new lesions [Figure 3].
Figure 2: Histopathology of the biopsy specimen from the right chest. CD30, CD4-positive, large hyper-chromatic lymphocytes infiltrating the upper dermis. (a, b, Haematoxylin–eosin stain; c, immunohistochemistry, anti-CD30; d, immunohistochemistry, anti-CD4; original magnifications: a, X 12.5; b, X 200; c and d, X 40)

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Figure 3: Erythematous papules resolved and new lesions were not observed at the 6-month follow-up visit

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There is a significantly increased risk of second malignancy among breast cancer survivors.[1] In this case, the patient developed lymphomatoid papulosis limited to the previous mastectomy and lymph node dissection sites. Lymphomatoid papulosis is a cutaneous T-cell lymphoma with clinical features of chronic, recurrent, self-healing eruption of papules and small nodules. The lesions appear mainly as a generalized eruption of erythematous papules or small nodules on the trunk and proximal extremities. In some cases, lesions showed a herpetiform arrangement or appeared regionally in one anatomic area.[2]

A well-known secondary lymphoma at the surgical location is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a CD30-positive lymphoproliferative disorder associated with textured implants. Although the exact pathogenesis of BIA-ALCL is unclear, one hypothesis is that inflammatory cell aggregation induced by textured implants leads to immune dysregulation and cell proliferation.[3]

There was a similar case of lymphoma associated with breast cancer unrelated to breast implants. However, the relationship between the treatment of breast cancer and lymphomatoid papulosis was unclear in that it appeared as a single lesion, that it occurred away from the surgical site, and that it occurred 5 years after the end of treatment.[4] In our case, the lesions appeared within a year after treatment and developed within the surgical site and radiotherapy field. This suggests an association between lymphoproliferative disorder and chronic inflammation caused by surgery and radiotherapy. As another report contributing this association, a case of ALK1-negative ALCL arisen from an old burn scar has been described.[5]

Herein, we present a case of regional lymphomatoid papulosis suggesting that chronic inflammation can act as a risk factor for lymphomatoid papulosis. Further studies are needed to evaluate a causal relationship of chronic inflammation with lymphoproliferative disorder.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.



 
   References Top

1.
Bazire L, De Rycke Y, Asselain B, Fourquet A, Kirova YM. Risks of second malignancies after breast cancer treatment: Long-term results. Cancer Radiother 2017;21:10-5.  Back to cited text no. 1
    
2.
Martinez-Cabriales SA, Walsh S, Sade S, Shear NH. Lymphomatoid papulosis: An update and review. J Eur Acad Dermatol Venereol 2020;34:59-73.  Back to cited text no. 2
    
3.
Alotaibi S, Hamadani M, Al-Mansour M, Aljurf M. Breast implant-associated anaplastic large cell lymphoma. Clin Lymphoma Myeloma Leuk 2021;21:e272-6.  Back to cited text no. 3
    
4.
Haro R, Juarez A, Diaz JL, Santonja C, Manzarbeitia F, Requena L. Regional lymphomatoid papulosis of the breast restricted to an area of prior radiotherapy. Cutis 2016;97:E15-9.  Back to cited text no. 4
    
5.
Akdeniz Dogan Z, Miranda RN, Iyer S, Steiner RE, Singh P, Clemens MW. Anaplastic large cell lymphoma of the breast arising in a burn cicatrix. Aesthet Surg J 2020;40:NP159-63.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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