A CASE IS LINKED TO HISTOPATHOLOGY GROUP TOO:  
 
24 yrs Lady suffered from multiple biopsies (incl. excissional) with scarring due to multifocal lymphoid follicular hyperplasia (pseudolymphoma) from 2012 till now.  
Eruptions: violaceus, elevated (photo included), around postbiopsy scars.  
Biopsies: 2012 LEFT brachial skin, 2013 RIGHT humeral skin, 2015 RIGHT cheek/face...  
 
HISTO in all biopsies the same: tumoral, deep, fibrotic follicular hyperplasia. Only 2012 largest excission is included (2013 and 2015 smaller biopsies).  
 
IH: Nothing special in all biopsies: Bcl2(-) II follicles, no expansions of MZ or abberrancies. Ig kappa/lambda polytypical.  
Serology: Ab titers against Borrelia absent.  
MOLECS: IGH, IGK, TCRB, TCRG ir TCRD locuses- NONclonal profile.  
 
PROPOSAL/QUESTION: B lymphoid hyperplasia (multifocal/disseminated): what the cause is?  
 
thankyoubeeingtogether

gaulier 2016-08-11 10:59	On the different immunolabelling , I see a predominent Lambda expression in interfollicular areas.I cannot rule out a possible diagnosis of very low grade marginal zone lymphoma in wich germinal centers and mantle zones a reactionnal,the lymphomaous component beeing restrited to interfollicular areas.   By waiting the clonality result , the clinical investigations may try to demonstrate a possible eruption onset before 2012 following insect bite , a possible long standing drug exposure...
ugnius 2016-08-12 11:03	Thank you for a comment. A problem with (our at least) Ig lambda is that its always STONGER and more Noizzy. Any clonality was detected (appended above).
tzankov 2016-08-15 07:47	extranodal lymphoid heyperplasia incl. FH is often linked to inborn or acquired immunodeficiency states or to borreliosis. thus, resepctive testing (HIV? borrelia IgM/IgG? as well as immunofixation (e.g. hyper-IgM?) and some quantitatvie and qualitative T-cell tests) is indicated.
ugnius 2016-08-15 11:09	Thanx, Alex. In single follicles Ig lambda slightly monotypical (as mentioned above by dr.A.Gaulier), bu NOT clonal. All your mentioned notes were included into report. See you in Basel soon.
tzankov 2016-08-15 11:30	please let me know, if the work-up brought something into view
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