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Lymphocytic panniculitis: an algorithmic approach to lymphocytes in subcutaneous tissue
  1. Carolyn J Shiau1,2,
  2. Marie S Abi Daoud3,
  3. Se Mang Wong4,
  4. Richard I Crawford2,4,5
  1. 1Department of Pathology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
  2. 2Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
  4. 4Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Carolyn J Shiau, Department of Pathology, Royal Columbian Hospital, 330 Columbia Street East, New Westminster, British Columbia, Canada V3L 3W7; Carolyn.Shiau{at}fraserhealth.ca

Abstract

The diagnosis of panniculitis is a relatively rare occurrence for many practising pathologists. The smaller subset of lymphocyte-predominant panniculitis is further complicated by the diagnostic consideration of T cell lymphoma involving the subcutaneous tissue, mimicking inflammatory causes of panniculitis. Accurate classification of the panniculitis is crucial to direct clinical management as treatment options may vary from non-medical therapy to immunosuppressive agents to aggressive chemotherapy. Many diseases show significant overlap in clinical and histological features, making the process of determining a specific diagnosis very challenging. However, with an adequate biopsy including skin and deep subcutaneous tissue, a collaborative effort between clinician and pathologist can often lead to a specific diagnosis. This review provides an algorithmic approach to the diagnosis of lymphocyte-predominant panniculitis, including entities of septal-predominant pattern panniculitis (erythema nodosum, deep necrobiosis lipoidica, morphea profunda and sclerosing panniculitis) and lobular-predominant pattern panniculitis (lupus erythematous panniculitis/lupus profundus, subcutaneous panniculitis-like T cell lymphoma, cutaneous γ-δ T cell lymphoma, Borrelia infection and cold panniculitis).

  • DERMATOPATHOLOGY
  • LUPUS
  • LYMPHOCYTES
  • CONNECTIVE TISSUE DISEASES
  • LYMPHOMA

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