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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 1772 - 14 March - Dr Uma Sundram 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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Clinical History: 55 year old man with rapidly growing lesion under right eye.

Case Posted by Dr Uma Sundram


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Dr. Mona Abdel-Halim

Posted

Thinking lymphoma, NK/T cell lymphoma, or T cell lymphoma (aggressive epidermotropic or gamma delta) ... needs IHC. 

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Sasi Attili

Posted

5 minutes ago, Dr. Mona Abdel Halim said:

Thinking lymphoma, NK/T cell lymphoma, or T cell lymphoma (aggressive epidermotropic or gamma delta) ... needs IHC. 

agree

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Raul Perret

Posted

Agree with NK/T cell lymphoproliferations spectrum. IHC is needed.

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vincenzo polizzi

Posted

Yes Lymphoma, agree with Mona. 

This is a rapidly growing lesion, and usually MF are slow  chronically growths. CD8+ aggressive epidermotropic T cell Ly are usually multiple lesions. NK/T nasal type Ly are usually necrotic mass...What about a type B folliculotropic Lymphomatoid Papulosis?  Thinking so because some cells look like CD30 anaplastic ones...but agree with above: IHC is mandatory. 

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Alice Roberts

Posted

Likely a Tcell lymphoma... check any history MF. IHC stains to further classify

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I am thinking in CD8+ aggressive epidermotropic T cell Lymphoma despite being so rare. I would expect more necrosis or angioinvasion for NK-T cell lymphoma. IHQ and hybridization for EBV are necesssary.

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Robledo F. Rocha

Posted

Clinical history of an adult presenting with a rapidly growing lesion which microscopically shows a diffuse, vaguely nodular, proliferation of pleomorphic lymphocytes with pronounced pagetoid epidermotropism makes me think of primary cutaneous peripheral T-cell lymphoma. Immunophenotype determination shall differentiate between primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma and cutaneous γ/δ T-cell lymphoma. The former one is favored since there seems to be no marked involvement of the dermoepidermal interface nor the subcutaneous fat.

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Nitin Khirwadkar

Posted

Agree with a lymphoma. Likely CD8+ epidermotropic T cell NHL.

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Josie Bisi

Posted

 

9 hours ago, vincenzo polizzi said:

Yes Lymphoma, agree with Mona. 

This is a rapidly growing lesion, and usually MF are slow  chronically growths. CD8+ aggressive epidermotropic T cell Ly are usually multiple lesions. NK/T nasal type Ly are usually necrotic mass...What about a type B folliculotropic Lymphomatoid Papulosis?  Thinking so because some cells look like CD30 anaplastic ones...but agree with above: IHC is mandatory. 

I agree with you. Nice shot.

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Uma Sundram

Posted

The lesion was strongly CD30+, CD3+, CD56-, EBV-. Interestingly, the intraepidermal components were CD4-CD8-, leading us to wonder if this is a CD30+ lymphoproliferative disorder with the 6p25.3 rearrangement (DUSP22/IRF4). We called the clinician and the patient has one lesion, favored clinically to be ALCL. Systemic work up was negative and the patient had no lesions of MF. Features that distinguish this case from other pcALCLs include 1) extensive epidermotropism 2) relatively small cells in the dermal compartment, as opposed to true 'pennies on a platter' anaplasia typical of pcALCL 3) lack of expression of CD4 and CD8 within the intraepidermal components. The FISH test was positive, confirming that the patient had the 6p25.3 rearrangement (Onandia A et al. Histopathology 2015; 66(6):846-55).  

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