Case Number : Case 777 - 10th June Posted By: Guest

[color=#444444][font=arial, sans-serif][size=1][right]Localized dense lymphohistiocytic infiltrate with Grenz area below epidermis.D.D may include pseudolymphoma, lymphoma, plasmacytoma, and Langerhans cell histiocytosis .IHC is recommended .Initial panel may include,CD3, CD4, CD5, CD7,CD8,CD20,CD1a,,CD68,kappa and lambda light chains, Bcl2,Bcl6, and [/right][/size][/font][/color][color=#444444][font=arial, sans-serif][size=1][right]CD138 (Syndecan-1).[/right][/size][/font][/color]

My first impression is anaplastic large cell lymhoma vs. diffuse large B-cell lymhoma

Lymphoma vs. pseudolymphoma for work up

I think this is a lymphoma. My favorite is anaplastic large cell lymphoma.

[color=#000000][color=#000000]A dense mixed infiltrate with predominance of small lymphocytes and plasma cells, but with the remarkable presence of eosinophils, worrisome large cells and some mitotic figures.[/color][/color]
[color=#000000][color=#000000]My first impression is pseudolymphoma due to many features that suggest a benign condition:[/color][/color][list]
[*][color=#000000][color=#000000]this [/color][color=#000000]non-ulcerated[/color][color=#000000] lesion is [/color][color=#000000]symmetric and well-circumscribed;[/color][/color]
[*][color=#000000][color=#000000]it shows a [/color][color=#000000]top-heavy / wedge-shaped arrangement of the infiltrate;[/color][/color]
[*][color=#000000][color=#000000]there is also Grenz zone, spared epidermis, and prominent blood vessels with plump endothelial cells.[/color][/color]
[/list]
[color=#000000][color=#000000]I favor lymphomatoid drug eruption, maybe associated with [url="http://www.ncbi.nlm.nih.gov/pubmed/7632065"]antidepressant therapy[/url].[/color][/color]

Agree with the above of lymphoma vs. pseudolymphoma. Recurrent nodules in the history would favor a benign reactive process. Stain panel similar to Maria's with light chain would be worthwhile to begin a workup. There is no reactive follicular architecture present. If malignant, a MZL or less likely FCL (diffuse pattern) would be in my differential given the persence of plasma cells and lymphoplasmacytoid cells.

My first impression was nodular scabies (nodular infiltrate heavy in plasma cells and sparse eosinophils). Lots of plasma cells so easy enough to do a Kappa and Lambda to r/o lymphoma.

The diagnosis for this was lymphoproliferative disorder - lymphomatoid papulosis.

Thank you [color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4][right]Iskander .But from A-E ,which type you gave it to this one?[/right][/size][/font][/color]

Lymphomatous cutaneous infiltrates are really a jack-in-the-box!
I would classify this as a type A (histiocytic type) lymphomatoid papulosis. Do the panel agree?

[i]Lymphoepithelial carcinoma[/i]

A bit late. My first impression was Lyp

Pseudo lymphoma vs. lymphoma for immunostudy