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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 1581 - 18 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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M90. Serpiginous granulomatous lesion right medial calf.


Dr Richard Carr


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Cutaneous infiltration by lymphomatous cells. My first hypothesis is PCDLBCL-leg type. Waiting the immunostains.

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vincenzo polizzi

Posted

Yes. Favour DLBCL leg-type. There are centrocytoid cells among the blastic ones.

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The immunostais show positive result for CD20, BCL-2, BCL-6 and MUM-1, confirming the impression of PCDLBCL leg-tyoe.

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Dr. Mona Abdel-Halim

Posted

Yes, DLBCL, leg type

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Raul Perret

Posted

Just to add to the discussion. PCFCCL can have a predominance of large cells (usually with centroblast morphology) and therefore come to the differential diagnosis. However, the topography is not the typical one for PCFCCL and the strong expression of BCL-2 and MUM-1 altogether with this predominance of large cells favour primary cutaneous large b-cell lymphoma (leg type) over the latter. 

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Also just to add, when the PCFCCL appears in the legs it carries a worse prognosis.

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Dr. Richard Carr

Posted

Yes we reported it as favouring DLBCL, in keeping with primary cutaneous, leg-type but of course pending staging and CPC.  Agree with discussion. Presume the population of small cells are mainly T-'s.  Robson et al recently reported on p16 (I think) in DDx of PCDLBCL, leg-type from FCCL (but I cannot now locate the reference!). Incidentally EBER was negative.  Ki67 was moderate ~50%.

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