A retrospective review of cutaneous lymphoma in Botswana

• Published in: International journal of dermatology Vol. 59; no. 3; pp. 352 - 358
• Main Authors: Rodriguez, Olaf, Sowash, Madeleine, Mosojane, Karen I., Ralefala, Tlotlo, Grover, Surbhi, Haun, Paul, Kovarik, Carrie, Williams, Victoria L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-03-2020
• Subjects: Biopsy; Botswana; CD4 antigen; CD8 antigen; Demographics; Demography; Dermatology; Diagnostic systems; Epstein-Barr virus; Female; Histology; Humans; Immunohistochemistry; Lymphoma; Lymphoma, Non-Hodgkin - diagnosis; Lymphoma, Non-Hodgkin - therapy; Male; Morbidity; Mortality; Mycosis; Mycosis fungoides; Patients; Rare diseases; Retrospective Studies; Skin; Skin Neoplasms - diagnosis; Skin Neoplasms - therapy; Viruses; Botswana; Africa
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.14690

Background
Primary cutaneous lymphoma (PCL) represents a heterogeneous collection of non‐Hodgkin lymphomas originating in the skin. Our study describes the clinical and histological findings of cutaneous lymphoma within Botswana to expand the paucity of data on this rare disease in sub‐Saharan Africa.
Methods
We conducted a retrospective review from the dermatology clinic at Princess Marina Hospital (Gaborone, Botswana) of patients evaluated by skin biopsy for cutaneous lymphoma between 2008 and 2017. Patients with initial diagnostic suspicion for cutaneous lymphoma had biopsies re‐reviewed by experienced dermatopathologists and were given a final diagnosis of either (i) cutaneous lymphoma, (ii) atypical lymphocytic infiltrate (ALI), or (iii) a reactive cutaneous process.
Results
Thirty‐eight cases were identified with a mean age of 50.0 years and a male:female (M:F) ratio of 13:6. Final diagnoses included: 27 cases of cutaneous lymphoma, eight cases of ALI, and three cases of reactive cutaneous processes. Subtypes of cutaneous lymphoma diagnosed included: mycosis fungoides (MF) (81.5%), plasmablastic lymphoma (7.4%), Epstein‐Barr virus‐positive T‐cell lymphoma (3.7%), subcutaneous panniculitis‐like T‐cell lymphoma (3.7%), and peripheral T‐cell lymphoma, not otherwise specified (3.7%). The most common immunohistochemical staining profile in MF cases was CD8 predominance over CD4.
Conclusions
Primary cutaneous lymphoma causes significant morbidity and mortality globally. Given the limited resources in sub‐Saharan Africa, it is essential to educate providers on the manifestations and histology of PCL. This study is an important step towards understanding the demographics, clinical presentation, histologic features, and mortality of patients diagnosed with PCL in Botswana and similar low‐resource settings.