Histology

Microscopic examination shows a nodular dermal infiltrate with reactive follicles (Fig. 2). In addition, there is a rather diffuse infiltrate containing T cells, histiocytes, eosinophils, and polyclonal plasma cells. The presence of macrophages containing ingested nuclear material (Flemming's tingible body macrophages) within the follicles producing a "starry sky'' pattern is a common feature in B-PSL (Fig. 3). The infiltrate is predominantly located in the upper and middermis, but may extend

Figure 2 Lymphadenosis benigna cutis: dense lymphocytic infiltrate with follicular pattern.

Figure 3 Lymphadenosis benigna cutis: reactive follicle with germinal center and tingible body macrophages containing ingested nuclear material.

into the deep dermis. Small groups of lymphoid cells between collagen bundles may be observed at the periphery of the lesions. This is a helpful histological criterion in the differentiation from cutaneous B-cell lymphoma (CBCL), in which the nodular infiltrate shows convex rather than concave sharply demarcated borders. Measuring microvessel density and vessel distribution may provide another helpful criterion to discriminate between CBCL and B-PSL (4).

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