Borrelial pseudolymphoma, more commonly known as Borrelia lymphocytoma and previously also as lymphadenosis benigna cutis, is a rare manifestation of Lyme borreliosis, which occurs nearly always in children after an infection caused by Borrelia afzelii; this pathogen is transmitted exclusively by the Ixodes ricinus tick in our region. The most common body locations of this lymphocytoma include the earlobe, scrotum, nipples and the areomamillary complex. Therefore, the case of our patient was unexpected and quite rare. The aim of this article is to point out the high incidence of Lyme disease and its atypical manifestations which can be cured without surgical intervention in most cases. The authors describe the case of a 58-year-old healthy female patient with a very rare manifestation of Lyme disease.

• Klíčová slova
• Borrelia burgdorferi, Ixodes, Lyme disease, pseudolymphoma, skin neoplasms,
• MeSH
• Borrelia burgdorferi komplex * MeSH
• Borrelia * MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymeská nemoc * komplikace   diagnóza   epidemiologie   MeSH
• obočí patologie   MeSH
• pseudolymfom * diagnóza   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Lichen aureus is a variant of pigmented purpuric dermatoses. The usual histopathology of lichen aureus is characterized by a subepidermal dense, band-like lymphocytic infiltrate, extravasated erythrocytes, and hemosiderin deposits. We report three patients with lichen aureus on the extremities with similar clinical, dermoscopic, and histopathological findings characterized by a dense band-like relatively deep dermal infiltrate accompanied by extravasation of erythrocytes and hemosiderin deposits occasioning a resemblance to a lymphoproliferative disorder.

• Klíčová slova
• lichen aureus, mycosis fungoides, pigmented purpuric dermatosis, pseudolymphoma,
• MeSH
• dermatoskopie metody   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• erytrocyty patologie   MeSH
• hemosiderin analýza   MeSH
• imunohistochemie metody   MeSH
• kožní nemoci patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfocyty patologie   MeSH
• lymfoproliferativní nemoci metabolismus   patologie   MeSH
• plazmatické buňky patologie   MeSH
• poruchy pigmentace patologie   MeSH
• pseudolymfom komplikace   patologie   MeSH
• purpura diagnóza   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• hemosiderin MeSH

INTRODUCTION: Pseudolymphoma is a rare focal lesion which occurs in different locations. Only about 50 cases of liver pseudolymphoma have been reported so far. The diagnostic process is challenging. The lesion can resemble different malignancies using various imaging methods. No typical laboratory markers are available. The right diagnosis is usually made on the basis of histological examination. CASE REPORT: A 67 years old female patient with lung fibrosis was undergoing assessments for a malignant-appearing focal lesion of the left lung and a focal liver lesion of unknown etiology. Upper lobectomy of the left lung proved lung carcinoma. The liver lesion was suspected for being metastatic, therefore a liver resection followed. The biopsy revealed hepatic pseudolymphoma. It took 150 days from the first positive CT scan until the liver resection. Currently, the patient shows no signs of recurrence. CONCLUSION: Hepatic pseudolymphoma is a rare disease and we have only little experience with it so far. The diagnostic process is challenging, which is clear from the presented case. Only histological and immunohistochemical examinations ruled out a malignancy. A long-term observation of the patient is indicated.

• Klíčová slova
• liver, liver surgery, liver tumours, pseudolymphoma, reactive lymphoid hyperplasia of the liver,
• MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory plic * diagnostické zobrazování   MeSH
• nemoci jater * diagnostické zobrazování   MeSH
• pseudolymfom * diagnostické zobrazování   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Here, we present the case of a 50-year-old woman diagnosed with stage I hormone-dependent breast cancer. The patient underwent partial mastectomy followed by adjuvant radiotherapy and hormone treatment with tamoxifen. Three years later, she presented with a solitary liver lesion on MRI, which was highly suspicious of malignancy. However, several fine needle biopsies were performed, and histopathological examination revealed no signs of neoplasia. As a result of these alarming discrepancies, the multidisciplinary board recommended a diag-nostic laparotomy, which yielded a finding consistent with reactive lymphoid hyperplasia, a pseudolymphoma of the liver, on a background of incipient steatohepatitis. This rare condition is characterized by proliferation of non-neoplastic lymphocytes in extranodular sites, and is usually an incidental finding on imaging modalities in clinically asymptomatic patients, predominantly women. Lesions share some radiologic features with primary malignant liver diseases such as hepatocellular carcinoma or cholangiocarcinoma. Although the etiology remains unclear, reactive lymphoid hyperplasia is believed to be associated with some malignancies, including breast cancer, or inflammatory and autoimmune disorders. Reactive lymphoid hyperplasia usually progresses slowly, with some cases of spontaneous regression described in the literature. To the best of our knowledge, only 50 cases of hepatic reactive lymphoid hyperplasia have been reported so far.Key words: pseudolymphoma - hyperplasia - liver - lymphatic tissue The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 20. 3. 2017Accepted: 10. 4. 2017.

• MeSH
• laparotomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mastektomie MeSH
• nádory prsu farmakoterapie   chirurgie   MeSH
• pseudolymfom patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE: We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS: We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS: Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS: This retrospective study was limited by the small number of patients. CONCLUSION: In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.

• Klíčová slova
• T cell, borreliosis, cutaneous T-cell lymphoma, interstitial granulomatous dermatitis,
• MeSH
• akrodermatitida etiologie   MeSH
• bakteriální nemoci kůže diagnóza   imunologie   patologie   MeSH
• Borrelia burgdorferi izolace a purifikace   MeSH
• chronická lymfatická leukemie komplikace   MeSH
• diferenciální diagnóza MeSH
• DNA bakterií izolace a purifikace   MeSH
• dospělí MeSH
• erytém etiologie   MeSH
• fibróza MeSH
• histiocyty patologie   MeSH
• kousnutí klíštětem komplikace   mikrobiologie   patologie   MeSH
• kožní T-buněčný lymfom diagnóza   MeSH
• kůže imunologie   mikrobiologie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymeská nemoc komplikace   diagnóza   imunologie   patologie   přenos   MeSH
• pseudolymfom diagnóza   imunologie   patologie   MeSH
• receptory antigenů T-buněk gama-delta genetika   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• T-lymfocyty patologie   MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• DNA bakterií MeSH
• receptory antigenů T-buněk gama-delta MeSH

The relationship between Epstein-Barr virus (EBV) and the germinal centre (GC) of the asymptomatic host remains an enigma. The occasional appearance of EBV-positive germinal centres in some patients, particularly those with a history of immunosuppression, suggests that EBV numbers in the GC are subject to immune control. The relationship, if any, between lymphoid hyperplasia with EBV-positive germinal centres and subsequent or concurrent lymphomagenesis remains to be clarified. As far as the development of EBV-associated Hodgkin's lymphoma is concerned, the suppression of virus replication, mediated by LMP1 on the one hand, and the loss of B-cell receptor signalling on the other, appears to be an important pathogenic mechanism. A further important emerging concept is that alterations in the microenvironment of the EBV-infected B-cell may be important for lymphomagenesis.

• MeSH
• B-lymfocyty imunologie   virologie   MeSH
• buněčná diferenciace imunologie   MeSH
• dospělí MeSH
• Hodgkinova nemoc imunologie   virologie   MeSH
• infekce virem Epsteina-Barrové virologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• proteiny virové matrix MeSH
• pseudolymfom virologie   MeSH
• receptory antigenů B-buněk imunologie   MeSH
• replikace viru imunologie   MeSH
• virus Epsteinův-Barrové imunologie   MeSH
• zárodečné centrum lymfatické uzliny imunologie   virologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• EBV-associated membrane antigen, Epstein-Barr virus MeSH Prohlížeč
• proteiny virové matrix MeSH
• receptory antigenů B-buněk MeSH

• MeSH
• dospělí MeSH
• kožní nemoci patologie   MeSH
• lidé MeSH
• pseudolymfom patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Lyme borreliosis is the most common human tick-borne illness in the Northern Hemisphere. The causative agent is the spirochete Borrelia burgdorferi species complex, and the hard-shell ticks of the genus Ixodes is responsible for pathogen transmission from animals to humans. The incidence of the disease is increasing year by year and although lyme disease is not fatal, it can affect the skin, heart, nervous, and musculoskeletal system with an impairment of quality of life. The appropriate diagnosis of lyme disease should be promptly treated by antibiotics to prevent late stage of the disease. The choice of antibiotics depends on many factors such as the stage of the disease, the drug efficacy, adverse effects, type of delivery, duration of treatment, and cost. Treatment failure occurs as a result of many reasons, re-infection is possible. The recommended treatment schedule in the Czech Republic is presented.

• MeSH
• akrodermatitida farmakoterapie   mikrobiologie   MeSH
• antibakteriální látky aplikace a dávkování   terapeutické užití   MeSH
• antibiotická profylaxe * MeSH
• dítě MeSH
• dospělí MeSH
• erythema chronicum migrans farmakoterapie   mikrobiologie   MeSH
• lidé MeSH
• lymeská nemoc komplikace   diagnóza   farmakoterapie   mikrobiologie   patologie   MeSH
• mladiství MeSH
• neúspěšná terapie MeSH
• pseudolymfom farmakoterapie   mikrobiologie   MeSH
• rozvrh dávkování léků MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• antibakteriální látky MeSH

We present a series of 15 cases of cutaneous lymphoma and pseudolymphoma with dual lineage rearrangement identified among approximately 1200 cases of cutaneous lymphoproliferative disorders assessed in our 4 institutions during the last 8 years in which the results of both T-cell receptor and immunoglobulin heavy chain rearrangement investigations were available. On the basis of the clinicopathologic information, the cases were retrospectively subdivided into 2 categories: (1) cases with definite features of cutaneous lymphoma or pseudolymphoma (n = 11) and (2) cases with unclassifiable disease (n = 4). The detection of dual genotype in the first group did not influence the final diagnosis; 7 cases represented cutaneous B-cell lymphomas, 3 pseudolymphomas, and 1 case lymphomatoid papulosis. The presence of monoclonal T-cell receptor-gene rearrangements in these cases may be explained either by monoclonal or oligoclonal expansion of exuberant T cells (or B cells in case of lymphomatoid papulosis) or by lineage infidelity. Three patients with unclassifiable disease had several clinical and histopathologic features in common. They were elderly, presented with solitary lesions, were in good general health and histopathologically demonstrated a dense multinodular infiltrate containing approximately an equal number of T and B cells and a high number of histiocytes forming granulomas, with prominent granulomatous features in 2 cases. B cells were either scattered with the infiltrate or formed collections vaguely resembling follicles; Reed-Sternberg-like cells were seen in 2 cases. B cells showed expression neither of immunoglobulin light chain. The T-cell component was represented mainly by small, well-differentiated lymphocytes or slightly pleomorphic cells, with some medium-sized convoluted cells. Epstein-Barr virus was not detected by polymerase chain reaction. The exact classification of these cases is unknown; they differ histopathologically from previously published cases of bigenotypic cutaneous lymphomas. They may merely represent a growth or reactive pattern, but, on the other hand, may be low-grade lymphomas. If so, they may be histopathologically related to cutaneous Hodgkin disease, T-cell/histiocyte-rich large B-cell lymphoma, or composite lymphomas. Further reports are needed to identify these lesions to clarify their nature and biologic potential.

• MeSH
• B-buněčný lymfom patologie   MeSH
• B-lymfocyty patologie   MeSH
• buňky Reedové-Sternberga patologie   MeSH
• dospělí MeSH
• genová přestavba B-lymfocytů * MeSH
• genová přestavba T-lymfocytů * MeSH
• histiocyty patologie   MeSH
• Hodgkinova nemoc diagnóza   MeSH
• kožní T-buněčný lymfom patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfom patologie   MeSH
• lymfoproliferativní nemoci klasifikace   genetika   patologie   MeSH
• nádory kůže genetika   patologie   MeSH
• polymerázová řetězová reakce MeSH
• pseudolymfom patologie   MeSH
• receptory antigenů T-buněk genetika   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• T-lymfocyty patologie   MeSH
• těžké řetězce imunoglobulinů genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• receptory antigenů T-buněk MeSH
• těžké řetězce imunoglobulinů MeSH

This study characterizes the clinicopathological spectrum of lymphoproliferations involving the breast nipple and/or areola. Morphologic, immunohistochemical, molecular-genetic, and clinical features of 58 specimens from 56 patients were analyzed. They were re-diagnosed as cutaneous lymphoid hyperplasia (CLH, n = 44); other benign lymphoid infiltrates (OBLI, n = 8); peripheral T-cell lymphoma, not otherwise specified (n = 1); cases with overlapping features of CLH and B-cell lymphoma (n = 3), one of them composed of spindle cells. Cutaneous lymphoid hyperplasia infiltrates were dense, composed mainly of B cells forming follicles with germinal centers (GC). Cutaneous lymphoid hyperplasia frequently showed features suggesting a malignancy as coalescing follicles with non-polarized germinal centers lacking mantle zones, and smudged infiltrates of lymphoid cells spreading into collagen (often as "Indian files"), smooth muscle, vessel walls, and nerve sheaths. Only two cutaneous lymphoid hyperplasias recurred; otherwise all patients are without disease (mean follow-up 62 months). Monoclonal rearrangement of immunoglobulin heavy chain gene was detected in five, and of T-cell receptor gamma gene in two cutaneous lymphoid hyperplasias using polymerase chain reaction (PCR), but the patients fared well too. In 47% of cases Borrelia burgdorferi was detected by polymerase chain reaction and/or serology, of which one was monoclonal. We conclude that cutaneous lymphoid hyperplasia is the most common lymphoproliferation of the breast nipple, rarely recognized clinically, and often overdiagnosed histologically as lymphoma.

• MeSH
• Borrelia burgdorferi MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• geny TcR gama MeSH
• hyperplazie genetika   mikrobiologie   patologie   MeSH
• imunohistochemie MeSH
• kožní nemoci genetika   mikrobiologie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymeská nemoc komplikace   MeSH
• lymfom patologie   MeSH
• lymfoproliferativní nemoci genetika   mikrobiologie   patologie   MeSH
• mladiství MeSH
• polymerázová řetězová reakce MeSH
• přestavba genů pro těžké řetězce B-lymfocytů MeSH
• prsní bradavky mikrobiologie   patologie   MeSH
• pseudolymfom genetika   mikrobiologie   patologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH