Dermatopathology Self Assessment
Transcript of Dermatopathology Self Assessment
3rd BSDDermatopathology Self Assessment
Case BSD 2015 12
M.Y.Walsh
CLINICAL HISTORY
• 72 year old male
• Recent history of colitis
• Bilateral lower limb weakness
• Chest infection
• Rash over back macular
• Rash on scalp raised and indurated
• Positive serology luetic disease
Histological features biopsy on scalp
• Epidermaltrophism of atypical lymphocytes into the epidermis, hair follicle epithelium and skin appendage epithelium.
• Atypical lymphocytes extend into dermis
•
Histology features biopsy back
• Epidermaltrophism by atypical lymphocytes
• Pautrier’s microabscess
• Lymphocytes large ,atypical convoluted nuclei
• Similar infiltrate in dermis
• Follicular epithelium shows epithelial trophism
• None of the biopsies had large numbers of plasma cells
• Warthin –Starry stains negative
• Immunocytochemistry negative for Treponema pallidum
• Diagnosis at this stage
• Cutaneous T cell lymphoma(mycoses fungoides)
• Immunocytochemistry on all biopsies gave a similar pattern of staining
IMMUNOCYTOCHEMISTRY
• CD20 –ve
• CD79a-ve
• CD3 +ve
• CD4+ve
• CD8++ve
• CD15-ve
• Cd30-ve
Diagnosis on basis of immunocytochemistry
• CD8 predominate T cell lymphoma(CD 8 predominant mycoses fungoides)
Mycoses fungoides
• Usually CD4 > CD8 but 10% CD8>CD4.
• Both types usually have an indolent clinical course
IMMUNOCYTOCHEMISTRY
• CD56 -ve Beta F 1 +ve
• CD43 +ve Mib-1 +++ve
• CD117 -ve TIA 1 -ve
• CD138 -ve
• CD2 +/-ve
• CD5 +ve
• CD7 +ve
Imminocytochemistry
• There is a clinical and histological overlap with gamma delta CTCL.
• Beta F-1 postivity helps to distinguish epidermotropic CD8+ve cytotoxic CTCL which is positive with beta F-1.
• HIV negative
PCR
• PCR showed positive Tcell receptor gene rearrangement
BSD 2015 12
• A. Syphilis
• B. Anaplastic large cell CD30 lymphoma.
• C. Primary cutaneous aggressive epidermotrophic CD8postive cytotoxic Tcelllymphoma
• D. Diffuse large B-cell lymphoma.
Diagnosis
• Primary cutaneous aggressive epidermotropicCD8 +ve cytotoxic cutaneous lymphoma
Prognosis
• Aggressive lymphoma
Clinical course
• Patient developed lymphomatous deposits in the lung,brain and other organs and died a few months after his presentation
TYPICAL CLINICAL FEATURES
• Generalized skin lesions including scaling patches and plaques,papules ,nodules and tumour.
• Oral involvement common
• Dissemination to unusual sites,lung ,brain, testis.
• Lymph nodes may not be involved
Primary cutaneous aggressive epidermotropic CD8+ve cytotoxic
cutaneous Tcell lymphoma
• Is a distinct subgroup
• Prominently epidermotropic infiltrate
• Aggressive clinical behaviour
• Distinct clinical presentation
IMMUNOCYTOCHEMISTRY
• CD20 -ve
• CD79a -ve
• CD3 -ve
• CD4 +ve
• CD8 ++ve
• CD15 -ve
• CD30 -ve