Case Number : Case 1794 - 13 April - Dr Arti Bakshi Posted By: Guest

Some Maundy Thursday magic from Dr Arti Bakshi to get you all ready for the Easter Break.

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lichenoid pigmented purpuric dermatosis of Gougerot Blum

Another PPD-like MF? Atypical cytological and architectural features are more subtle this time, and this diagnosis is harder to support, but..why not? Clinical history, long time and solitary lesion, fits well ( solitary MF-patches are well described as better prognosis cases ). 

There are lichenoid features, also, and lymphocytes aren't larger than dermal ones.

However the intradermal and demo-epidermal arrangement of lymphocytes seems a little linear, with halos and with very poor spongiosis. 

Lichenoid purpura (1 lesion: lichen aureus?) or hemorrhagic MF are my 2 differentials.

I thought this was a case of lichenoid PPD (if the images we see here are completely representative of the lesion). I think our tolerance threshold for diagnosing MF has diminished lately due to the cases seen in dermpathpro. But for me this is PPD

Agree with colleagues

Agree, favor pigmented purpuric lichenoid dermatitis of Gougerot and Blum.

Yes, I called it lichenoid PPD too. Could well be a pigmented purpuric lichenoid dermatitis of Gougerot and Blum. (although the clinical history did seem to imply a single lesion).

I did not think there was lymphoid atypia and did not do any immunos, when I reported this case. However, when I was putting the case on dermpathpro, I did wonder if I should have....but I agree with Raul that this is likely to be the effect of this website!! Having said that, I think subtle forms of lymphoid atypia is one of the most subjective things in dermpath, and if you stare at a lymphoid cell long and hard enough, it does turn atypical!!. Sometimes its the associated epidermal reaction, which is more useful. There was clearly basal vacuolar damage, colloid bodies and spongiosis in this case all pointing to a reactive process.  If one compares this case to Richard's case of purpuric MF from last week, these epidermal changes were lacking in his case.

Thanks for all your comments.