Oral manifestations of Hydroa vacciniforme‐like lymphoproliferative disorder: a clinicopathological study of a Peruvian population

• Published in: Journal of oral pathology & medicine 2021-07, Vol.50 (6), p.530-539
• Main Authors: López de Cáceres, Cinthia Veronica Bardález, Rodrigues‐Fernandes, Carla Isabelly, Rendón Henao, Javier, Morais, Thayná Melo de Lima, Soares, Ciro Dantas, de Almeida, Oslei Paes, Fonseca, Felipe Paiva, Delgado‐Azañero, Wilson
• Format: Article
• Language: English
• Subjects: Buccal mucosa; CD8 antigen; Cytotoxicity; Dentistry; EBV; Edema; Epstein-Barr virus; Fever; Hybridization; Hydroa vacciniforme‐like lymphoma; Hydroa vacciniforme‐like lymphoproliferative disease; Hydroa vacciniforme‐like lymphoproliferative disorder; Immunohistochemistry; Immunoproliferative diseases; Leukocytes (eosinophilic); Leukocytes (neutrophilic); Lip; Lymphatic diseases; Lymphocytes; Lymphoid cells; Lymphoma; Macrophages; Patients; Phenotypes; Plasma cells; Population studies; Rare diseases; Ulcers
• ISSN: 0904-2512; 1600-0714
• DOI: 10.1111/jop.13203

Background Hydroa vacciniforme‐like lymphoproliferative disorder (HVLPD) is a chronic Epstein‐Barr virus (EBV)‐positive lymphoproliferative disease which may either present as an indolent condition or progress to a systemic T‐cell lymphoma. Methods All HVLPD diagnosed over a 10‐year period were retrieved, and clinical data regarding sex, age, oral and systemic manifestations, and clinical follow‐up were obtained. Immunohistochemistry was done in order to characterize the lymphoid cells, and in situ hybridization was used to demonstrate the presence of EBV. Results Eleven cases were included, with a male predominance and a mean age of 25.1 years. Buccal mucosa and the lips were the most affected oral sites, appearing as painful ulcers. All patients exhibited facial oedema, usually affecting the lips, nose and periorbital region. The clinical course was gradual but progressive, with four patients having fever and 3 showing lymphadenopathies. All cases showed a moderate to severe lymphocytic infiltrate with angiotropism, angiocentricity and epidermotropism. Two cases affecting the lip skin exhibited a periappendageal lymphocytic infiltrate. Few large pleomorphic cells were found, surrounded by smaller and medium‐sized lymphoid cells, as well as reactive plasma cells, macrophages, neutrophils and eosinophils. All lesions exhibited a cytotoxic T‐cell (CD8+) phenotype with a variable proliferative index. All cases were associated with EBV, and all patients died due to complications of the disease. Conclusions HVLPD is a rare disease that may show oral involvement with a cytotoxic T‐cell phenotype, and is strongly associated with EBV. As shown in this series, HVLPD may show aggressive clinical behaviour.