Case Number : Case 2049 - 13 April 2018 Posted By: Iskander H. Chaudhry

I think that this is a case of follicular lymphomatoid papulosis. Since it shows a wedge shaped infiltrate and epidermotropism, it may alternatively be called LyP with overlapping type A and B features

Before IHC images I was thinking of PLEVA or some odd Pagetoid Reticulosis ( 6 month is a long interval time for LyP-lesional-regression..., and didn't see any large atypical intradermal cell ), but CD30 remark many large intrafollicular cells and too many intraepidermal cells, so I agree with Anil: Type F Lymphomatoid Papulosis. 

Same here, first though was PLEVA then I think with the CD30, it is LyP

Nice "controversial" case. I'd stick with PLEVA. By coincidence had e-mail correspondence with Werner Kempf about distinguishing LyP type D (epidermotropic) from PLEAVA with CD30+ve cells bottom line appeared to be it can be impossible. I might send Werner the link to the case.

Probably a reactive CD30+ inflammatory response, favor PLEVA

Dear Richard

Thank you so much for the link to this great case. ......

Based on the cytomorphology of the cells, the extent of vacuolization, the erythrocyte extravasation, the number of apoptotic keratinocytes as well as the number of neutrophils in the hyperparakeratosis I favor CD30+ PLEVA in this case. The clinical presentation seems to me compatible with PLEVA. Clonality studies do not help in this situation as PLEVA harbors clonal T-cells in up to 60% of the cases. The course and the lack of scar formation could help. 

Warm regards

Werner Kempf

From Dr Chaudhry:

Thank you we favoured CD30+ PLEVA for the reasons mentioned by Richard