Case Number : Case 2519 - 03 March 2020 Posted By: Uma Sundram

granulomatous inflammation - no necrosis with dense collections of lymphocytes

Lupus vulgaris.

I was wondering whether we need to consider  lymphoepithelioid variant of peripheral T-cell lymphoma old term lenient lymphoma

I need PCR for MTB or IHC to know the clonality of the cells. please suggest

Difficult. Granulomatous or lipogranulomatous lymphadenitis, with some toxoplasmosis-like finding ( but there aren’t hyper plastic lymphoid follicles). It needs CPC. 

The lymphoid component is so dense and made me think like Krishnakumar in Lennert's lymphoma. Needs work up both for infectious causes as well as lymphoproliferative processes associated with granulomatous reaction. 

I really liked all of your suggestions! It's very subtle, but the first picture has an epidermal inclusion cyst/dilated hair follicle in it. This is an exuberant cutaneous lymphoid hyperplasia in response to rupture. Although the lymphocytes are dense, they have many architectural features of a reactive process. Special stains are negative for organisms. Cultures are negative and T cell PCR is polyclonal.