Lymphomatoid Papulosis Type D or an Aggressive Epidermotropic CD8+ Cytotoxic T-cell Lymphoma?

Lymphomatoid papulosis (LyP) is defined as a chronic, recurrent, self-healing eruption of papules and small nodules, characterised by a waxing and waning course, and by histological features of a CD30(+) cutaneous T-cell lymphoma CTCL. Classically, 3 histologic subtypes of LyP are recognised: Type A (histiocytic), type B (MF-like) and type C (anaplastic like CTCL) (1). Together with primary cutaneous anaplastic large T-cell lymphoma, LyP is classified as a part of the primary cutaneous CD30(+) lymphoproliferative disorders in the WHO-EORTC classification of cutaneous lymphomas (2). Recently, a new histologic LyP variant termed type D, simulating an aggressive epidermotropic CD8(+) cytotoxic T-cell lymphoma, but with the typical clinical presentation and indolent course of LyP, has been described (3-5). We describe a new case of this variant, of which diagnosis is particularly challenging and emphasises the importance of cross-disciplinary collaboration.