Grange F, Wechsler J, Guillaume JC, et al: Borrelia burgdorferi--associated lymphocytoma
cutis simulating a primary cutaneus large B-cell lymphoma.
Four patients who had received tick bites while visiting forests in Mexico had skin lesions that met the case definition of erythema migrans, or borrelial lymphocytoma.
Two (36 and 54 years of age) had erythema migrans lesions, and 2 (9 and 34 years of age) had borrelial lymphocytoma lesions.
Serum samples from the 2 lymphocytoma patients were positive for B.
Biopsy samples of lymphocytoma lesions showed dense nodular lymphocytic infiltrates in the reticular dermis with well-delineated lymphoid follicles, no atypical mitosis, B-lymphocytes (anti-CD20, DAKO, Carpenteria, CA, USA) in the germinal center (Figure 2, panel A), T-lymphocytes (anti-CD45 RO+) in the follicular zone (Figure 2, panel B), and no CD3+ cells.
For the lymphocytoma case, we found 2 base substitutions, the same as those of the erythema migrans cases, including the nonconserved base substitution (online Appendix Figure, panel C).
Borrelial lymphocytoma is a rare clinical entity reported mostly in Europe (12-14) and sporadically in the United States (15).
Borrelia burgdorferi associated lymphocytoma cutis: clinicopathologic, immunophenotypic, and molecular study of 106 cases.
10,14,17) The differential diagnosis of cutaneous splenosis includes differentiated cutaneous lymphoma, lymphocytoma
, nodular Kaposi sarcoma, and subcutaneous vascular malformations.