Unlike T-cell neoplasms, B-cell lymphoproliferative disorders have a limited clinical spectrum of skin involvement. Cutaneous B-cell neoplasms mimicking rosacea or rhinophyma are rare.
We described 12 patients with B-cell lymphoproliferative neoplasms presenting with a facial eruption clinically mimicking rosacea or rhinophyma. Eleven patients were women; ages ranged from 36 to 81 years. The clinical presentation included small papules on the nose and cheeks and around the eyes mimicking granulomatous rosacea; nodules on the nose, cheeks, chin, or forehead mimicking phymatous rosacea; or a combination of both. Three patients had preexisting erythematotelangiectatic rosacea and 1 had rhinophyma. Based on a clinicopathologic correlation and B-cell clonality analysis, the diagnosis was primary cutaneous follicular center B-cell lymphoma in 4 cases, primary cutaneous marginal zone lymphoma in 6, and skin involvement of chronic lymphocytic leukemia in 2. All patients had an indolent course as expected for their disease.
Cutaneous involvement of B-cell neoplasms may mimic granulomatous rosacea or rhinophyma. This unusual clinical presentation is more common in women and appears in the setting of preexisting rosacea or as a new eruption. Proliferative B-cell disorders should be added to the differential diagnosis of symmetric papular or papulonodular eruptions of the face.
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Figure 1. Erythematous (granulomatous rosacea-like) papules on the right cheek in a patient with primary cutaneous follicular center B-cell lymphoma (patient 1).
Figure 2. Rhinophymalike lesion in a patient with primary cutaneous marginal zone lymphoma (patient 11).
Figure 3. Papular/granulomatous rosacea-like lesions on the background of preexisting erythematotelangiectatic rosacea. Small erythematous papules that were determined to be primary cutaneous marginal zone lymphoma were found on erythema and telangiectasia (patient 3). This patient had papules on both cheeks and also on the submental areas.
Figure 4. Histological features of primary cutaneous follicular center B-cell lymphoma (patient 8). A, Superficial and deep nodular aggregates show irregular lymphoid germinal center–like areas (hematoxylin-eosin, original magnification ×20). B and C, The areas are composed of small and large B lymphocytes (hematoxylin-eosin [B] and CD20 [C], original magnification ×400).
Figure 5. Histological features of primary cutaneous marginal zone lymphoma (patient 3). A, Superficial and deep nodular aggregates are seen (hematoxylin-eosin, original magnification ×20). B and C, The aggregates show distended marginal zones of monocytoid B cells (hematoxylin-eosin [B] and CD20 [C], original magnification ×200). C, The residual germinal center reveals positive staining for CD20 and negative staining for bcl-2. D, The marginal B cells are positive for bcl-2 (original magnification ×200).
Figure 6. Leukemia cutis of chronic lymphocytic leukemia mimicking phymatous rosacea (patient 4). A, Erythematous plaques and nodules on the nose, cheeks, and chin. B, Diffuse lymphocytic infiltrate involving the dermis (hematoxylin-eosin, original magnification ×40). C, The infiltrate is composed of small round lymphocytes and larger cells (prolymphocytes and paraimmunoblasts) (hematoxylin-eosin, original magnification ×400). D, Results of the IgH study show identical clones (dark filled peaks marked by arrows at 125 kilobase) in the skin biopsy specimen (top) and in the peripheral blood (bottom). The y-axes show peak intensity, measured in arbitrary units; the x-axes show DNA fragment size, measured in kilobases.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
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