“What’s in a Name....
Entry posted by Alistair Robson
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...a rose by any other name would smell as sweet?†Well, on this occasion I don’t agree, Mr Shakespeare. This is particularly the case when the name is “pseudo-lymphomaâ€, an oft used term in dermatopathology, guaranteed to make my hackles rise. Part of my ire stems from the pathologist “diagnosing†pseudo-lymphoma - an oxymoron in my view. To diagnose is to a) recognise a disease or 
to find the cause of (a problem). So, concluding with pseudolymphoma means that whatever else you might have done you have not made a diagnosis. The typical context is familiar; a dense lymphoid infiltrate, perhaps some cytological atypia, variable epidermal involvement, no tattoo, for example, or a history of vaccination site, or other potential cause; not being convinced the infiltrate is malignant a “diagnosis†of pseudolymphoma is made,with the wonderful illusion that one’s work is done, a label affixed. Move on. In some instances the cause is known, such as drug-induced pseudolymphoma in a patient on anti-epileptics. This latter use is less irksome, I’ll concede, but either one can make a diagnosis or one can’t. If there are no persuasive diagnostic features in such an infiltrate then maybe one is dealing with a pseudo-pseudolymphoma viz. a lymphoma. A lymphoid infiltrate of unknown significance is a more correct, certainly honest, admission to the clinician. Yesterday, I could have signed out pseudo-dermatomyositis (drug-reaction), pseudo-eczema (pityriasis rosea), pseudo-psoriasis (seborrheic dermatitis). So, let’s drop pseudolymphoma as a pseudo-diagnosis, or risk another gem from the Bard, Macduff’s lament, “Confusion now hath made his masterpiece“.
to find the cause of (a problem). So, concluding with pseudolymphoma means that whatever else you might have done you have not made a diagnosis. The typical context is familiar; a dense lymphoid infiltrate, perhaps some cytological atypia, variable epidermal involvement, no tattoo, for example, or a history of vaccination site, or other potential cause; not being convinced the infiltrate is malignant a “diagnosis†of pseudolymphoma is made,with the wonderful illusion that one’s work is done, a label affixed. Move on. In some instances the cause is known, such as drug-induced pseudolymphoma in a patient on anti-epileptics. This latter use is less irksome, I’ll concede, but either one can make a diagnosis or one can’t. If there are no persuasive diagnostic features in such an infiltrate then maybe one is dealing with a pseudo-pseudolymphoma viz. a lymphoma. A lymphoid infiltrate of unknown significance is a more correct, certainly honest, admission to the clinician. Yesterday, I could have signed out pseudo-dermatomyositis (drug-reaction), pseudo-eczema (pityriasis rosea), pseudo-psoriasis (seborrheic dermatitis). So, let’s drop pseudolymphoma as a pseudo-diagnosis, or risk another gem from the Bard, Macduff’s lament, “Confusion now hath made his masterpiece“.
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