Case Number : Case 2291 - 26 March 2019 Posted By: Iskander H. Chaudhry

lupus panniculitis vs. T-cell lymphoma. Favor lupus panniculitis based on the nuclear debris. But definitely one of the most difficult subjects in dermatopathology, even with immunohistochemical studies and T-cell gene arrangement testing, in my opinion.

Clinicopathologic correlation needed.

necrosis and mixed inflammatory cells/vascular damage seen-panniculitis

rule out erythema induratum/TB suggest PCR for MTB on the sections.

Difficult indeed, but favor Subcutaneous Panniculitis-Like T Cell Lymphoma (SCPLTCL)

7 hours ago, anh said:

lupus panniculitis vs. T-cell lymphoma. Favor lupus panniculitis based on the nuclear debris. But definitely one of the most difficult subjects in dermatopathology, even with immunohistochemical studies and T-cell gene arrangement testing, in my opinion.

Clinicopathologic correlation needed.

Agree...favor Lupus Panniculitis because the lobular necrosis with neutrophils looks like an early hyalinization.

Very interesting case. There is some superficial and deep perivascular and periadnexal mixed infiltrated with lobular paniculitis, at high power there are neutrophils, fat necrosis with nuclear debris and vasculitis changes mainly in the arterioles with fibronoid necrosis. This is highly suspicious of Erythema Nodosum Leprosum to me.

lobular panniculitis. favor lupus profundus( lupus panniculitis)

I would agree with Krishnakumar. Panniculitis with vasculitis suggests erythema induratum of Bazin. There are no lymphoid follicles to support lupus nor is there a clear cut rimming to support SPTCL. As far as ENL is concerned,  there should be background lepromatous granulomas of foamy cells which are not seen here. However, clinicopathological correlation is vital as any of these conditions is likely. 

Favor LE Profundus, will do CD3, CD20, CD123, Ki67, CD4 and CD8

E induratum, rule out lupus maybe.

sir final diagnosis