lymphocytoma cutis or LYMPHOMA part 2

Dr. Rockoff,

If you recall, previously helathy 40 year old female with a persistent nodule on right cheek. Slightly itchy. 1cm diameter, .5 cm tall. Oval shape. Seems like there is a whitish epicentre, peak of sorts...but perhaps I am misinterpreting, assuming it is a cyst of some sort. And there is more under the surface like a semi hard glue ball...Am tempted to stick it with a needle and squeeze the hell out of it...but i won t. When I stretch the skin around it, the peak is more apparent and it is not that well demarcated from the surrounding skin...no dark periphery...The initial path report reads:

Gross examination: Acne Cyst
Micro Examination: In this punch biopsy the epidermis is within normal limits. The dermis showas a fairly dense aggregated infiltrate of lymphocytes and histiocytes as well as some plasma cells. the infiltrate is around vessels as well as depper nodular aggregate extending to the subcutaneous tissue. There is also some inflammation around some of the hair follicles. the polymorphous nature of the infiltrate would suggest possible lymphocytoma cutis. HOWEVER, as this is a fairly dense infiltrate and is extending quite deep it is not possible to rule out lymphoma. The block will be sent for cell markers.

Diagnosis: Dense Lymphocytic Infiltrate

What do you make of this, doctor...What parts point to benign and what to malignancy...and what are they looking for now to make it conclusive...
I fear lymphoma... especially, secondary... Have no other symptoms, feel fine, energetic, just worried sick over this..Thanks for your help, comments, feedback...

S

[Alan Rockoff, MD]

I am always hard put to understand why people like yourself who consult doctors in person and have tests done and have questions about the tests don't ask the doctors who saw them and did the tests, instead of directing questions to strangers on the internet.  However, since you asked, I will say that this report sounds like that of a traumatized cyst, one that you perhaps squeezed, and that the inflammation accounts for all the lymphocytes.  For more information, you'll have to await the results of the cell markers.  meantime, please continue to leave the spot alone.

Thanks.

Dr. Rockoff