Our Dermatol Online Our Dermatol Online 2081-9390 Our Dermatology Online Poland OURD-8-98 10.7241/ourd.20171.26 Letter to the Editor Pautrier-Woringer disease: lipomelanotic reticulosis/dermatopathic lymphadenitis Hadj Olfa El Amine El Bouhajja Leila Goucha Aida Rekik Wafa May Ahmed El Gamoudi Amor Immuno-Histo-Cytological Department, Salah Azaiez Institute Tunis, Boulevard 9 Avril, Bab Saadoun 1006 Tunis, Tunisia Corresponding author: Dr. Olfa El Amine El Hadj, E-mail: olfaelamine@yahoo.fr 2017 8 1 98 99 10032016 05062016 Copyright: © Our Dermatol Online 1 2017

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 <p>Sir,</p> <p>We report a 62 year-old woman with a 20-year’s history of extensive psoriasis, and thyroidectomy, presented with a 3-month history of multiple hypertrophied axillary lymph nodes. At first the diagnosis of metastatic breast cancer was suggested. Physical examination revealed a 2cm, firm and slightly mobile axillary lymph node. A cutaneous diffuse psoriasis was observed on the chest and upper limbs. The breast mammography showed foci of microcalcifications (ACR3) in the right breast, and bilateral axillary lymphadenopathies. The cervical and abdominal ultrasonographies were normal. A surgical resection of the axillary mass was performed. Grossly, the lymph node measured 2,5cm in size, had a soft consistency with black pigment on the cut. Histological examination showed large melanin granules in intra and extra cytoplasmic cells (<xref ref-type="fig" rid="F1">Fig. 1</xref>). Paracortical and interfollicular spaces were colonized by a proliferation of histiocytes and interdigitating cells with elongated shape nuclei (<xref ref-type="fig" rid="F2">Fig. 2</xref>). They were organized in very large nodules. Immunohistochemical evaluation showed intense and diffuse expression of S-100 protein and CD1a attesting of the interdigiting nature of cell proliferation. On the other hand, the cytokeratin antibody was negative. The patient received medical treatment, no other lymph nodes was found. These features confirmed the diagnosis of Dermatopathic lymphadenitis. At 3 years of follow-up, the patient was asymptomatic and there was no recurrence.</p> <fig id="F1"> <label>Figure 1</label> <caption> <p>Node structure with large melanin granules in intra and extra cytoplasmic cells.</p> </caption> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OURD-8-98-g001.tif"/> </fig> <fig id="F2"> <label>Figure 2</label> <caption> <p>Paracortical and interfollicular proliferation of histiocytes and interdigitating cells with elongated shape nuclei with abundant melanin deposit.</p> </caption> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OURD-8-98-g002.tif"/> </fig> <p>Dermatopathic lymphadenitis (DL) also known as lipomelanotic reticulosis or Pautrier-Woringer disease, represents a rare form of benign lymphatic hyperplasia associated with most exfoliative or eczematoid inflammatory erythrodermas, including pemphigus, psoriasis, eczema, neurodermatitis, and atrophia senilis. It involves the axillary, inguinal and cervical regions [<xref ref-type="bibr" rid="ref1">1</xref>-<xref ref-type="bibr" rid="ref3">3</xref>]. These Lymph nodes are moderately enlarged, firm, movable, and rather painless [<xref ref-type="bibr" rid="ref4">4</xref>]. Diagnosis of DL is mostly based on the lymph node biopsy [<xref ref-type="bibr" rid="ref5">5</xref>]. The differencial diagnosis includes anthracosis, melanoma metastasis and mycosis fungoides. DL is a benign process and management of these patients consists in simple clinical, mammographic and ultrasonographic follow-up [<xref ref-type="bibr" rid="ref6">6</xref>].</p> <p>Dermatopathic lymphadenitis is a benign lymphatic hyperplasia, histologically usually mimicking lymphoma. Immunohistological exam is of great apport for differential diagnosis.</p> <sec id="sec2-1"> <title>Consent

The examination of the patient was conducted according to the Declaration of Helsinki principles. Written informed consent was obtained from the patient for publication of this article.

The patient’s informed consent was obtained.

Prior to the study, patient gave written consent to the examination and biopsy after having been informed about the procedure.

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