Case Number : Case 1184 - 6th January Posted By: Guest

I see some atypical lymphocytes, some of them with twisted nuclei, focally into the epidermis. With the clinical history of papules that come and go my fist impression is of a type B Lymphomatoid Papulosis.

[color="#000000"][font="Arial, sans-serif"][size=4]Agree with Igor. Case history and microscopic images point to type B lymphomatoid papulosis.[/size][/font][/color]

Agree that histo consistent with LyP. However I have never seen LyP resolve in 2 weeks!! Could this be a LyP like insect bite reaction?

How about PLEVA (with atypical CD30+ cells). Some cases are viral e.g. parvo B19

[color="#000000"]Lymphomatoid papulosis. [/color]

LyP.

Agree with LyP.

I think the atypical cells are so prominent... In PLEVA one can find few atypical cells but here I think the extent of atypia favours LyP.

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201184%20-%20SD_US-028-F5.jpg[/img]

Yes, I too thought lymphomatoid papulosis, and as you can see, CD30 is positive in the larger cells. I wasn't very clear on the clinical history--the lesions were ongoing and had a waxing and waning quality, evolving over a 2-4 week period. The patient almost always had lesions at different stages of evolution, typical of Lyp. As you all know, types A, B and C can merge into each other. These are better described and more easily recognized than the more recent group of Lyp types. PLEVA and insect bites are both great thoughts; PLEVA can be very difficult to distinguish from Lyp. The number of atypical cells seen here are perhaps more numerous than one typically did see in PLEVA; however, early in the discovery of Lyp this entity was thought to be a PLEVA-variant so the clinical is very important. Insect bites are very tricky as there can be significant overlap with Lyp; again, the clinical is very important.

I forgot to add that in last week's case of pcALCL and this week's case of Lyp, correlation with clinical findings AND clinical follow up are necessary to arrive at the appropriate diagnosis--in some cases, one cannot be sure even with an experienced clinician. That is the tricky aspect of cutaneous lymphomas!! Keeps us on our toes.