Case Number : Case 1958 - 30 Nov 2017 Posted By: Arti Bakshi

Epidermotropism with lymphocytes in the epidermis larger than those in the dermis,  Pautrier microabscess and history of widespread rash, all point towards MF going into Sezari syndrome

I have the same impression as Anil

Yes. At least 3 clues to MF/SS: 1) hyperkeratosis with some papillary dermal fibrosis point toward a long time lesion...2) intraepidermal lymphocytic nuclear sizes 3) exocytosis without spongiosis.

MF/SS is certainly part of the differential, but one must also consider drug eruptions within the differential diagnosis; without clinical correlation, we would not be able to tell the difference.

I think more information is needed before one suggest an appropriate diagnosis, the perivascular lymphocytic infiltrate is strikingly tight "coat-sleeve like".

Do these papules wax and wane, leave scars i.e Lymphomatoid papulosis course especially type B or fixed and not evolving?

Is he on any medication, as lymphomatoid drug eruption "pseudolymphoma" can be papular and look like MF on histology?

If above is negative, then one can consider MF but this will be a "papular" MF which a very rare sub-variant, one still have to examine the patient for any patches or plaques of the disease somewhere else, occasionally only observation and the time course will clarify.

CPC is needed, Papular MF tops the list

Intriguing case. CD30+ intraepidermal cells could be more in keeping with type B LyP... But I don’t see any pleomorphic dermal infiltrate ( also the monomorphic variant of LyP as Type B shows some pleomorphism ). The papular variant of MF should well be the transformation early stage of MF, so I favour PAPULAR MYCOSIS FUNGOIDES. 

Great discussion!

This is a case of LyP type B. The similarity to MF is striking and essentially, the 2 are indistinguishable histologically. Clinically, the lesions were papular and underwent spontaneous regression.There were no patches or plaques. 

This case shows CD30 positivity in the intraepidermal cells, but remember LyP type B can be entirely CD30 negative, making the diagnosis even more difficult. As always, CPC is key to the diagnosis.

Fantastic case Arti - I have not seen a case personally (if you know what I mean).

Thanks Richard!