Jump to content
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 2473 - 26 December 2019 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

17M, non-healing lesion right axilla

Edited by Admin_Dermpath


  • Like 1
  Report Record

User Feedback


Dr. Mona Abdel-Halim

Posted

Anaplastic large T cell lymphoma will be my first thought.  Also secondary cutaneous involvement from Nodal Hodgkin disease should be considered. IHC is mandatory. 

Share this comment


Link to comment
Share on other sites

Krishnakumar subramanian

Posted

ulcerating lesion in axilla with dense large atypical cells in the superficial, mid dermis and deep dermis and also extending into sub cutaneous fat. there is secondary epidermal changes. There is also anglocentric lesions down in dermis

CD 30 IHC, CD8, CD4, and other panel of cytotoxic markers. Also clinical information if it is single lesion or multiple lesions waxing and waning. considering the young age I would also consider lymphomatoid papulosis if the history is supportive

Also peripheral smear and EBNA in tumor cells.

Anything in axilla LCH to be considered but so atypical and mitosis LCH I am not considering 

Share this comment


Link to comment
Share on other sites

On 27/12/2019 at 15:22, Dr. Mona Abdel-Halim said:

Anaplastic large T cell lymphoma will be my first thought.  Also secondary cutaneous involvement from Nodal Hodgkin disease should be considered. IHC is mandatory. 

AGREE!

Share this comment


Link to comment
Share on other sites

Epidermal hyperplasia is a good clue for Anaplastic large cell lymphoma.

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Secondary cutaneous is more likely from the underlying lymph node. Could be nodal ALCL. 

Share this comment


Link to comment
Share on other sites

Saleem Taibjee

Posted

Great responses. Yes, this is CD30 positive anaplastic large cell lymphoma. As Richard correctly surmised, ALK was positive, and the patient was subsequently shown to have underlying axillary nodal disease, and referred to our regional young adult haemato-oncology team for further management.

The comment about overlying epidermal hyperplasia is also very pertinent.

Well done, guys.

Below are the images of the CD30 and ALK.

Happy New Year!

Saleem

01728_5.0x CD30 labelled.jpg

01728_5.0x ALK labelled.jpg

Share this comment


Link to comment
Share on other sites

Saman Fatah

Posted

Thanks for the update Dr Taibjee, could you (or Dr Carr) kindly explain why secondary cutaneous involvement from nodal/systemic ALCL was favoured on H&E rather than primary cutaneous ALCL even before the knowledge of further clinical features/staging and ALK status? aware the ALK is not definite for secondary cutaneous disease. 

Many thanks.  

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

I based it on the clinical image / location and probabilities (sALCL is known to affect "children/young adults" whereas I'd guess from my experience cALCL is more likely to affect older adults and not be located over a lymph node basin). It was not based on histology but a "lucky" guess. 

About 2000 years ago Confucius said: “The more you know, the more luck you will have.”

1937 December 19, Los Angeles Times, On the Side with E.V. Durling, Page A1, Los Angeles, California. (ProQuest Historical Newspapers)

Share this comment


Link to comment
Share on other sites

Saman Fatah

Posted

Thanks very much Dr Carr for your explanation, honesty and sharing a useful wisdom from a Chinese philosopher/teacher stated ages ago.

Share this comment


Link to comment
Share on other sites



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...