Lymphadenosis cutis benigna

• Bäfverstedt 1944

• Spiegler 1894

• Burckhardt 1911

Lymphocytoma, lymphocytoma cutis, benign lymphoplasia of the skin; multiple sarcoid.

Gut-like cutaneous proliferation of the lymphoreticular tissue, e.g. induced by borrelia.

• Women > Men
• 2 age peaks:
  • Childhood/adolescence
  • 40-70 y.

• Trigger in approx. 1/3 of cases
  • Borellia
  • B. afzelii and B. garinii
• Trigger in approx. 2/3 of cases
  • Unexplained
    • Suspected
      • Medication
      • Insect bites
      • Vaccinations
      • Tattooing
      • Acupuncture
      • Trauma

2 main forms:

1. Lymphadenosis cutis benigna solitaria: solitary nodule (large-nodular solitary type) or regionally limited nodular infiltrates (small-nodular multiple type). Nodules are relatively sharply defined, soft, deep red to bluish-red in colour. Diascopy shows a yellowish grey, often lupoid infiltrate. Borrelia lymphocytoma is almost always found on the earlobe or on the nipple. Predilection sites are earlobes, neck, nipples, armpits, scrotum and extremities
2. Lymphadenosis cutis benigna dispersa: extensive, almost indurated infiltrates, without predilection sites and only occurring in adults

Other clinical variants:

-- disseminated miliary form: symmetrically arranged, 2-5 mm large, blue-red nodules, mainly on the face and trunk

-- spotted infiltrative form: bluish or brown-reddish, spot-like or plaque-like infiltrates, often with telangiectasia and haemosiderin deposits. Predilection site: legs. Conjunctiva and oral mucosa are very rarely affected.

• Anamnesis
  • Tick bite?
• Clinical picture
• Biopsy
• Laboratory
  • Borrelia serology
  • Optional
    • BSG ↑, BB (leukocytosis), serum IgM fraction ↑

Ear lobes, neck, nipples, armpits, scrotum, extremities

In the upper and middle dermis, dense, partially nodular, polymorphic lymphohistiocytic infiltrate. Plasma cells and eosinophils are often detectable, as are reactive germinal centres. Immunohistological: dense infiltrate of B cells partially surrounded by T cells. B cells are polyclonal.

1. Albrecht S, Hofstadter S, Artsob H, Chaban O, From L. Lymphadenosis benigna cutis resulting from Borrelia infection (Borrelia lymphocytoma). J Am Acad Dermatol 1991;24:621-5.
2. Buchner SA, Fluckiger B, Rufli T. [Infiltrating lymphadenosis benigna cutis as borreliosis of the skin]. Hautarzt 1988;39:77-81.
3. Hassler D. [Dermatologic findings in Lyme borreliosis. 4. borrelia lymphocytoma (lymphadenosis cutis benigna Baferstedt)]. Fortschr Med 1997;115:46-8.
4. Rijlaarsdam JU, Meijer CJ, Willemze R. Differentiation between lymphadenosis benigna cutis and primary cutaneous follicular centre cell lymphomas. A comparative clinicopathologic study of 57 patients. Cancer 1990;65:2301-6.
5. Afa G, Caprilli F, Crescimbeni E, Morrone A, Prignano G, Fazio M. [Anti-Borrelia burgdorferi antibodies in chronic erythema migrans, benign lymphadenosis cutis, scleroderma and scleroatrophic lichen]. G Ital Dermatol Venereol 1990;125:369-73.
6. Rijlaarsdam JU, Bruynzeel DP, Vos W, Meijer CJ, Willemze R. Immunohistochemical studies of lymphadenosis benigna cutis occurring in a tattoo. Am J Dermatopathol 1988;10:518-23.