Case Number : Case 1702 - 6 December - Dr Uma Sundram Posted By: Guest

Here is your Tuesday fix of Spot Diagnosis from Dr Uma Sundram

Cheers, Geoff Cross - DermpathPRO Projects

Lichen sclerosis( bxo)

Agree with lichen sclerosus

There are some features suggesting lichen sclerosus but the lymphocytes are a bit irregular, there is some basal epidermal tagging and haloes. Although rare in the pediatric population, I would like to rule out mycosis fungoides before performing the diagnosis of lichen sclerosus.

BXO. There is the characteristic broad hyalinized collagen band between lymphocytic dermal infiltrate and epidermis (sandwich sign) (Fig 2 ). Moreover phimosis is a well known case mimicking MF

Agree with lichen sclerosus. In the early phase, one can get tagging of lymphocytes along the DEJ in LS.

Yes, lichen sclerosus. It is a known pitfall for MF, but have never seen such prominent basal tagging and atypia...nice case!

Here is another reference; https://www.ncbi.nlm.nih.gov/pubmed/14631186

Lichen sclerosus. I see frequently lymphocytes tagging the basal epidermis on this location.

Mycosis fungoides-like lichen sclerosus. All those haloed lymphocytes within the lower layers of the epidermis really mimick mycosis fungoides, but correlation with clinical features will certainly rule out the hypothesis of lymphoma, even in cases that show monoclonality of the lymphocytic infiltrate (the reference cited above by Arti testifies this assertion), once solitary mycosis fungoides on genital skin is exceedingly rare to be considered as a reasonable diagnosis.

Yes this is lichen sclerosus and I have seen in presentations in conferences cases really mimicking MF in their early phases. 

Agree with LSA mimicking MF. tricky case!

I also favor LSetA

You guys nailed it! LS (BXO) mimicking mycosis fungoides. As mentioned, LS can be a histologic mimic of MF at early stages and can have + clonality so have to be careful when doing work up. The characteristic clinical setting is a tip off: young boy presenting with phimosis.

Great case, Uma!