Polymerase Chain Reaction Analysis of Immunoglobulin Gene Rearrangement in Cutaneous Lymphoid Hyperplasias

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Abstract
THE DIFFERENTIAL diagnosis of B-cell lymphoma and cutaneous lymphoid hyperplasia may be difficult. Divergence of clinical appearance is unreliable for differential diagnosis.1 Lymphoid hyperplasias mimic lymphomas histologically and it is often impossible for the dermatopathologist to make a conclusive diagnosis.2,3 Immunophenotyping with leukocyte monoclonal antibodies is helpful to detect monoclonal B-cell proliferation by light chain restriction.4,5 However, a discrete monotypic B-cell infiltrate can be masked by a dense reactive infiltrate.6 Molecular analysis of lymphoid gene rearrangements by Southern blot analysis has proved to be useful for the detection of clonal populations and the determination of the lineage of lymphomas.7 The polymerase chain reaction (PCR) technique has more recently been used for the rapid detection of gene rearrangements in lymphoid proliferations as an alternative to traditional Southern blot hybridization.8 We studied 24 patients with cutaneous lesions in which a diagnosis of B-cell pseudolymphoma was made after clinical, histological, and immunophenotypic evaluations. Immunoglobulin gene rearrangement analysis was performed by PCR in the cutaneous lesions to determine the interest of this technique for the differential diagnosis between cutaneous lymphoid hyperplasias and B-cell lymphomas. Whether the detection of a clonal rearrangement is predictive of a malignant outcome remains controversial.