Case Number : Case 1741 - 30 January - Dr Limin Yu Posted By: Guest

Start your week off with a neat case from Dr Limin Yu.

Geoff Cross - DermpathPRO Projects

Pityriasis lichenoides spectrum. Sudden onset favors PLEVA if supported clinically by presence of necrotic lesions.

Agree. I guess the large hypercromic lymphocytes are CD30 cells...

A hard case! Clinical history favors the acute form of pityriasis lichenoides, but caught my eyes the absence of extravasated erythrocytes and vacuolar change of the basal layer, and the presence of periadnexal lymphocytic infiltration. Were the lymphocytes abnormal and large, I’d go with lymphomatoid papulosis with 6p25.3 rearrangement due to the presence of, at low power magnification, pagetoid reticulosis-like epidermotropic lymphocytic infiltration and marked involvement of pilosebaceous units and eccrine glands.

Good suggestion by Robledo! Definitely need a CD30 in this case. However, PLEVA and LyP lie on a spectrum and one can get CD30+ cells in PLEVA. The clinical course of the disease would be important in the distinction.

I think this is PLEVA, but I liked Robledo´s idea.

I thought of PLEVA in this case as all of you guys suggested. My impression was that we see some extravasated erythrocytes (although not super prominent)

I am thinking of PLEVA. As Raul has commented, I too feel there is some RBC extravasation.

I think the invading lymphocytes are atypical and there is ulceration. I would go for lymphomatoid papulosis but clinico path correlation required.

I am thinking of PLEVA.  Focal loss of stratum corneum and spongiosis favour the diagnosis of PLEVA

You guys are awesome. Agree with respect!  This is a PLEVA. Your points are well taken!