Case Number : Case 2884 - 27 July 2021 Posted By: Iskander H. Chaudhry

There is predominance of CD4 cells, subtle epidermotropism more evident on IHC and papillary dermal fibrosis. Suspicious for mycosis fungoides, however a distinction from T-cell pseuodolymphoma or MF mimic requires clinical correlation and additional IHC such as loss of CD2, 5, 7. There also appears to be interstitial mucin deposition which has been described in some variants of MF. 

lupus tumidus, as there is perieccrine inflammation and there is mucin in dermis

can we have CD123 that will support lupus tumidus, as it can mimic Cutaneous Marginal Zone B-cell Lymphoma/T cell lymphoma

?Sezary/MF

Clinical correlation is mandatory. Favor lymphomatoid drug reaction.

The intraepidermal cells are many times larger than the dermal ones. 

Dr Chaudhry's response: 

Clinically the case was highly suggestive of MF. 

The case was reported as skin with mild acanthosis and a moderate lymphoid infiltrate in the papillary dermis with epidermotropism and rare atypical lymphoid cells expressing CD4. 

The features raise the possibility of early mycosis fungoides. Correlation with the clinical and cytogenetics are advised.

did not see convincing evidence of MF. but it may be an evolving one. have to rule out other mimickers such as lymphomatoid drug reaction