Case Number : Case 77 Posted By: Guest

Mona Abdel Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr McKee, So since the follicles are reactive, one can c a tingible body macrophage inside them?? Am I correct. Is there one here?

Submitted on 24/09/2010 21:37
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Phillip McKee - Overseas consultations (Arizona, USA) Wrote:

Well done Jonathan Shelton. This is a high power view showing several reactive follicles and an interfollicular infiltrate of hyperchromatic centrocyte-like cells. Obviously immunohistochemistry etc is necessary to come to a final diagnosis. The differential of B-cell pseudolymphoma is excellent. This is not a follicular lymphoma since the follicles are obviously reactive rather than neoplastic as would be seen in the latter condition.

Submitted on 24/09/2010 21:23
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr McKee, I think I was not understanding well what a tingible body looks like. I searched in the internet and found that it produced a starry sky appearance. Light colored macrophages among the blue lymphocytes and containing engulfed apoptotic debris. I think I can c one in the upper half of this field. Is that correct? And If yes is it enough to rule out lymphoma and favour a lymphoid hyperplasia simulating BCL? Are there any others in the field OR am I just imagining things. This area of BCL and lymphoid hyperplasia is so difficult to me. I will be glad if u explained things to us today.

Submitted on 24/09/2010 21:19
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I have read the comments. The idea of lymphocytoma cutis with tengible bodies sounds nice. Lymphoma also could be an important DDx as the infiltrate is dense and diffuse. But still I can see some ovoid bodies in what look like histiocytes.(I think they are so clear in the centre and in the lower left corner) Please Dr McKee, we need a thorough explanation of all the types of cells in this field.

Submitted on 24/09/2010 15:33
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Lushen Pillay - Wits Dermatology, South Africa (South Africa) Wrote:

? Lymphoma.

Submitted on 24/09/2010 14:52
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Donald Gates - USA () Wrote:

Follicular lymphoma

Submitted on 24/09/2010 14:32
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning everybody.. I was waiting for the case untill midnight here! I would put the 100X to see that bodies. I am not sure ir those are leishmania or tingible bodies. If therE are tingible bodies I would consider de diagnosis of lymphoid hyperplasia (linfocitoma cutis ) vs Extranodal marginal zone B-cell lymphoma (CD20+, bcl2+, bcl6-, CD10-)

Submitted on 24/09/2010 14:31
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

B cell lymphoma, would definitely do inmunohistochemistry

Submitted on 24/09/2010 14:12
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

B cell lymphoma, would definitely do inmunohistochemistry

Submitted on 24/09/2010 14:12
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Saleem Taibjee - Warwick and Birmingham () Wrote:

?Leishmaniasis

Submitted on 24/09/2010 12:45
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

I would consider Lymphoma (Mostly B-Cell lymphoma?)For immunohistochemistry to determine its type.

Submitted on 24/09/2010 11:30
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

T-cell/histocyte-rich B-cell lymphoma

Submitted on 24/09/2010 10:34
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Diffuse infiltrate made of lymphocytes and histiocytes. Small rounded to ovoid bodies (organisms) are seen inside the macrophages (parasitized macrophages)as well as free in the tissue. The organisms do not show surface budding and a septa can, with some difficulty, be seen in some of them. My diagnosis is Penicillosis (Infection with Penicillium mareffei).

Submitted on 24/09/2010 10:11
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Miah Singh - (UK) Wrote:

Difficult case- I think there are number of plasma cells and so wondered about Leichmaniasis

Submitted on 24/09/2010 10:08
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Jonathan Shelton - (UK) Wrote:

I would consider marginal zone lymphoma

Submitted on 24/09/2010 10:07
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Carlos B - Trainee (Spain) Wrote:

I note a late start today!! Could this be Rosai Dorfman Disease

Submitted on 24/09/2010 10:06
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