Case Number : CT0035 Adam_Bates

I think I am seeing a dense lymphocytic stromal infiltrate surrounding what looks like nests of poorly differentiated SCC. I think also that there is an epithelial giant cell. My first possibility is inflammatory SCC. Another DDx: is lymphoepithelioma like carcinoma.
 

Lymphoid infiltrate with giant cells with many nuclei. I would think in Granulomatous slack skin
 

Diffuse lymphocytic infiltrate with small lymphocytes and giant cells (some showing emperipolesis). Thought of granulomatous slack skin.
 

I want this to be granulomatous slack skin. Rather haloed lymphocytes with giant cells and emperipolesis. I think this is an exceedingly rare variant of MF as no one in the UK could provide me with a case when I needed it for a cutaneous lymphoma lecture!
 

Hi all, I think I was off the track! I was totally wrong. I re-examined the section, I agree with granulomatous slack skin. What I percieved as lymphocytes permeating an epithelial island is actually as u all said a multinucleated giant cell engulfing lymphocytes (emperiopolesis). Thank u all.
 

Granulomatous slack skin vs granulomatous MF
 

Good morning all. Richard, why didn't you ask me? Remember other lymphomas may have granulomata and giant cells! Phillip
 

One hugh osteoclast like giant cell with background mature lymphocytes - diagnosis - still could be lymphoid hyperplasia or reactive ??
 

The correct diagnosis is granulomatous slack skin. Granulomata may also be seen in: mycosis fungoides CD4+ small/medium T-cell lymphoma ATLL Subcutaneous panniculitis-like T-cell lymphoma Cutaneous marginal zone B-cell lymphoma The difference between GSS and granulomatous MF is one of degree. Emperipolesis and elastophagocytosis is much more pronounced in the former condition. In addition there are obvious clinical differences. Phillip