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Epidermotropism, not only a lymphocytic phenomenon


Dr. Mona Abdel-Halim

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For junior dermatopathologists, the word epidermotropism represents the synonym of MF. However, epidermotropism is not only a lymphocytic phenomenon. The word epidermotropism in medical dictionary means: movement towards the epidermis. It applies to the spread of different types of cells into the epidermis from an underlying dermal or subcutaneous pathology.

A very interesting review article is the one written by Abbas and Bhawan entitled: Epidermotropic lesions, a review*. They discussed all types of lesions showing the phenomenon of epidermotropism and the histological and immunohistochemical characteristics that differentiate them. Since lymphocytes are the most frequently encountered epidermotropic cells, epidermotropism is classified into lymphoid epidermotropism and non-lymphoid epidermotropism.

Lymphoid epidermotropism is mainly encountered in the context of CTCL with all its variants: MF, Sèzary syndrome, pagetoid reticulosis, primary cutaneous aggressive epidermotropic CD8+ TCL, CD30+ primary CTCL and adult T cell leukemia/lymphoma. However, it may be seen also in benign conditions such as: lichenoid keratosis, lymphomatoid keratosis and MF-like drug reaction.

Non lymphoid epidermotropism can occur with mammary Paget’s disease, extramammary Paget disease, Langerhans’ cell histiocytosis, Merkel cell carcinoma, sebaceous carcinoma, eccrine porocarcinomas, granular cell tumor, primary cutaneous epidermotropic alveolar rhabdomyosarcoma and epidermotropic metastasis

One should keep in mind also all intraepidermal conditions that mimic epidermotropism. These represent lesions originating in the epidermis and hence the proper definition of epidermotropism mentioned above does apply to them. They include benign conditions such as: Toker cells , pagetoid Spitz, nevi of special sites, pagetoid dyskeratosis, clear cell papulosis and mucinous metaplasia, as well as malignant conditions such as: malignant melanoma and pagetoid SCC in situ.

*Epidermotropic lesions, a review
Abbas O and Bhawan J
[i]J Cut Path, 2009: 36: 1037–1052[/i]
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