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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 809 - 24rd July Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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46-year-old male with a lesion on his right upper back.

Case posted by Dr. Hafeez Diwan.


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Guest Romualdo

Posted

Yes, primary cutaneous follicle-center lymphoma.

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Primary cutaneous follicle-center lymphoma x PCMZL x Cutaneous lymphoid hyperplasia (less probably). I think it is a primary cutaneous follicle center lymphoma and the reasons are the deep dermal involvement, extensive nodular architecture and upper back localization (Crosti lymphoma). I can not forget systemic follicular lymphoma with secondary cutaneous involvement. I had a case like this a couple of months ago. Waiting for Immunohistochemistry study.

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Dr. Mona Abdel-Halim

Posted

Crosti lymphoma... PCFCL

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Robledo F. Rocha

Posted

[color="#000000"][font="Palatino Linotype, serif"][size="4"]Unless immunohistochemistry study prove differently, it's a malignant lymphoid proliferation with nodular growth pattern since the fullthickness of the dermis is involved, mantle zone is nothing but a discontinuous narrow strip, and cell population do not include tingible body macrophages.[/size][/font][/color]
[color="#000000"][font="Palatino Linotype, serif"][size="4"]I did not find, surrouding the nodules, a pale area composed of cleaved cells, plasma cells, and lymphoplasmacytoid cells, a feature that, if present, would made me favor marginal zone B-cell lymphoma.[/size][/font][/color]
[color="#000000"][font="Palatino Linotype, serif"][size="4"]So, I will agree with the diagnosis of follicle center cell lymphoma, variant so-called Crosti's reticulohistiocytoma of the dorsum.[/size][/font][/color]

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Guest Jim Davie MD

Posted

[size=4]Agree with the above excellent differentials.
I favor PCMZL (primary cutaneous marginal zone lymphoma). Differential would include a diffuse-pattern high-grade FCL.

I believe there are rare scattered plasma cells (bottom left photo), and mixed monocytoid and larger centroblastic-type cells with frequent, focally aberrant mitotic figures, and absence of follicular architecture. There are nodular and focally infiltrative aggregates, that preferentially encase and infiltrate eccrine coils and follicular adnexa.[/size]

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Dr. Hafeez Diwan

Posted

The differential diagnosis is excellent. This turned out to be cutaneous lymphoid hyperplasia. The plasma cells were polyclonal, there were abundant CD3 positive cells with scattered clusters of CD20 positive and Bcl-6 positive cells.

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Dr. Richard Carr

Posted

Hafeez,
Fascinating case (I was favouring follicular lymphoma). This reminds me of a recent case I saw on biopsy (sizeable scalp nodules) strongly favouring follicular lymphoma (large expanded germinal centres on CD21) but on excision (with flow cytometry) favouring cutaneous follicular lymphoid hyperplasia (based on relatively high proliferation on Ki67 in the follicles). Plasma cells were mixed and flow cytometry favoured reactive. However it is well to remember this distinction can at times be impossible (possibly largely academic based on prognosis) but some cases may go on in time to more obvious lymphoma. What was the CD21 and CD10 in your case?
Regards

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Guest Jim Davie MD

Posted

Out of curiosity, what was the kappa/lambda ratio for the PCs?

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Dr. Hafeez Diwan

Posted

Yes, I was worried about this case as well. CD10 was negative. I didn't do a CD21. The kappa to lambda ratio was about 1:1. Since I was concerned about this case, I showed to our hemepath folks who went with CLH as well.

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