Kristina Buder

Primary cutaneous follicular helper T-cell lymphoma: diagnostic pitfalls of this new lymphoma subtype

The recently proposed entity of cutaneous follicular helper T (TFH) cell lymphoma (CTFHCL) harbors distinct clinical and histopathologic features. Here, diagnostic pitfalls are exemplified in a case report and by review of the literature. A 45‐year‐old patient developed rapidly growing nodules and plaques on upper arms and buttocks, which were initially misdiagnosed as primary cutaneous follicle center B‐cell lymphoma (CFCL). Consequently, systemic therapy with rituximab failed and consecutive skin biopsies revealed CTFHCL (CD3+CD4+CD10+PD‐1+bcl6+ICOS+CXCL13+). Interestingly, the prima vista PD‐1‐positive and CD10‐positive tumor cells lost PD‐1 expression in follow‐up biopsies while retaining CD10, ICOS and CXCL13 expression. All biopsy specimens displayed an identical clonal T‐cell population. Initially, nodules were controlled by local radiotherapy and oral psoralen combined with ultraviolet A (PUVA) therapy. However, disease recurred and progressed rapidly with disseminated nodules. Treatment with bexarotene, methotrexate and polychemotherapy failed to stop disease progression. Finally, modified total skin electron beam radiation resulted in complete remission. Disease stabilized on maintenance therapy with bexarotene in combination with ultraviolet A (UVA) therapy. The case highlights that because of concomitant B‐cell stimulation, CTFHCL clinicopathologically is prone to be mistaken for CFCL. Importantly, CTFHCL might lose PD‐1 while retaining CD10 expression in later stages, which may lead to confusion in distinguishing CTFHCL from CFCL.

Combined oral alitretinoin and narrowband UVB treatment of cutaneous T cell lymphoma: favourable response after multiple ineffective systemic therapies

ejd.2012.1857 Auteur(s) : Stephanie Motschenbacher, Kristina Buder, Matthias Goebeler, Andreas Kerstan kerstan_a@klinik.uni-wuerzburg.de Department of Dermatology, Venereology, and Allergology, University Hospital of Wurzburg, D-97080 Wurzburg, Germany Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema [1]. Due to its binding capability to both retinoic acid (RAR) [...]

Angiolymphoid hyperplasia with eosinophilia and Kimura's disease – a clinical and histopathological comparison

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular neoplasm mainly affecting middle‐aged women. Lesions typically affect the head and neck region. ALHE is considered a distinct disease entity different from Kimuras disease, a benign reactive lymphoid proliferation that is predominantly seen in young Asian men although it can affect all ethnic groups. In contrast to ALHE, Kimuras disease is typically associated with peripheral blood eosinophilia, increased serum IgE and lymphadenopathy. Several case reports suggest an overlap between ALHE and Kimuras disease. We review the current literature and discuss whether AHLE and Kimuras disease might represent two extreme variants of the same disease entity.

Angiolymphoide Hyperplasie mit Eosinophilie und Morbus Kimura – ein klinischer und histopathologischer Vergleich

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular neoplasm mainly affecting middle-aged women. Lesions typically affect the head and neck region. ALHE is considered a distinct disease entity different from Kimuras disease, a benign reactive lymphoid proliferation that is predominantly seen in young Asian men although it can affect all ethnic groups. In contrast to ALHE, Kimuras disease is typically associated with peripheral blood eosinophilia, increased serum IgE and lymphadenopathy. Several case reports suggest an overlap between ALHE and Kimuras disease. We review the current literature and discuss whether AHLE and Kimuras disease might represent two extreme variants of the same disease entity.

Residents’corner June 2014. Editorial: What’s new this month?

In this issue of the European Journal of Dermatology, Bircher et al.[1] revisit tolerance induction in drug hypersensitivity reactions, which is a controversial issue, particularly in delayed hypersensitivity reactions. Drug hypersensitivity may present as a mild, moderate or severe life-threatening reaction, becoming a problem for many patients when the offending drug is essential (and even irreplaceable).Determining which drug is responsible for the reaction may be challenging, especially in multiple [...]

Residents’corner February 2014. Editorial: What's new this month?

In this issue of the EJD, two articles shed light on sun-tanning behaviour in southern Europe [1, 2] that will be discussed here. We also critically review an article by Stockfleth et al. [4] who propose the ‘maximum lesion count’ as a new parameter for efficacy assessment of field-directed therapy for actinic keratoses. Last but not least, the publication of Mailhol et al. [5] on food allergies in children with atopic dermatitis will be reviewed.Skin cancer prevention is an important aspect [...]

Residents’corner April 2014. Nail it!: Eye-catching nail folds

A 62-year-old male patient was referred with a 6-month history of an erythematous face and hands. He complained about fatigue and particularly weakness of his shoulders and upper arms since 6 weeks.On clinical examination he presented with deep-red facial erythema sparing the perioral region, significant periorbital oedema, purple erythema on his decollete, erythematous macules and papules on the dorsal aspect of his fingers, especially over the bony prominences, and periungual erythema. Prominent [...]

Residents’ corner October 2014. Nail it! A bleeding tumour at the fingertip

A 48-year-old male patient presented with a fast-growing, bleeding tumour at the tip of his right middle finger. A few weeks before, a similar tumour had developed on his right index finger and had regressed spontaneously. The patient recalled repeated local trauma at the involved sites due to regular blood glucose testing in the past.He suffered from hearing loss and chronic renal failure due to Alport syndrome and had received a renal transplant. He also had hypertension, peripheral neuropathy [...]

Residents'corner December 2013. Editorial: what's new this month?

ejd.2013.2259 Auteur(s) : Rubeta NH Matin1 rnhmatin@doctors.org.uk, Alejandro Martin-Gorgojo2 alejandromartingorgojo@aedv.es, Ana Rita Travassos3 ritatravassos@gmail.com, Kristina Buder4 Buder_K@ukw.de, Helena Clayton5 helena.clayton@chuv.ch, Audrey Nosbaum6 NosbaumA@derm.ucsf.edu 1 Department of Dermatology, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ, United Kingdom 2 Dermatology Department, Clinical University Hospital of Valencia, University of Valencia, Av Blasco Ibanez 17, 46010 [...]

Residents’corner July 2013. Nail it! Painful toe nails in a young patient

ejd.2013.2209 Auteur(s) : Kristina Buder Buder_K@klinik.uni-wuerzburg.de, Stephanie Motschenbacher Department of Dermatology, Venereology and Allergology , University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 WURZBURG, Germany A 27-year-old female patient presented with painful thickened toe nails. Symptoms had started at least one year before and worsened continuously. The patient perceived scaly, erythematous skin lesions on her scalp two years earlier and in other sites thereafter. Medical [...]