|
Dermatopathology
Thursday, March 6, 2008, 7:30 PM
Convention Center 201 “Atypical” Lymphoid Infiltrates
|
Moderator:
|
BRUCE SMOLLER
University of Arkansas for Medical Sciences
Little Rock, AR
|
|
Disclosure:
|
The speakers have indicated they have nothing to disclose.
|
Clinical histories are displayed below.
For the fastest viewing of virtual slides, click:
under each thumbnail image below. You must have Aperio ImageScope installed on your PC.
|
If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy: | 
|
Or, click on slide thumbnail images to view each slide
in a Web-based slide viewer, which is somewhat slower.
If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137.
for Text and References
Submitted by: Victor G. Prieto
51-year-old white woman who developed red, indurated nodules involving her bilateral inner thighs. Clinical diagnosis: Panniculitis / abscess.
Case 1 - Slide 1
|
for Text and References
Submitted by: Victor G. Prieto
20-yo woman with a several-month history of subcutaneous nodules on the proximal arms and legs. Clinical diagnosis: r/o lymphoma.
Case 2 - Slide 1
|
for Text and References
Submitted by: Soon Bahrami
69 year-old male with 6 week history of a firm, somewhat linear plaque on right flank.
Patient has a history of rheumatoid arthritis and receives methotrexate and infliximab injections.
Case 3 - Slide 1
|
Case 3 - Figure 1
Scanning magnification demonstrates a punch biopsy with a superficial and deep lymphoid infiltrate. Papillary dermal edema is present.
|
Case 3 - Figure 2
Low power demonstrates a somewhat nodular infiltrate.
|
Case 3 - Figure 3
Small aggregates of histiocytes form vague granulomas admixed with lymphocytes.
|
Case 3 - Figure 4
Periadnexal infiltration is prominent.
|
Case 3 - Figure 5
Large transformed lymphocytes and mitotic figures are present.
|
Case 3 - Figure 6
Large transformed lymphocytes in addition to a vessel with plump reactive endothelial cells. An eosinophil is present under the vessel.
|
Case 3 - Figure 7
Haloed lymphocytes line the dermal-epidermal interface and exocytosis is present. Some intraepidermal lymphocytes have convoluted nuclei.
|
Case 3 - Figure 8 - CD20
CD20 highlights a few admixed B-cells.
|
Case 3 - Figure 9 - CD4
The infiltrate is predominantly composed of CD4 + T-cells.
|
Case 3 - Figure 10 - CD8
Quite a few admixed cytotoxic T-cells are also present.
|
Case 3 - Figure 11 - CD30
CD30 highlights scattered cells throughout the infiltrate.
|
Case 3 - Figure 12 - CD30
A closer look demonstrates that CD30 is staining the large transformed lymphocytes.
|
for Text and References
Submitted by: Soon Bahrami
15 year-old female with 4-week history of a rapidly appearing nodule on left lower eyelid.
Patient recalls a spider in her bed before the nodule appeared.
Patient has a history of ulcerative colitis s/p colon resection with stable disease on 6-mercaptopurine.
Case 4 - Slide 1
|
Case 4 - Figure 1
Scanning power shows a dense nodular infiltrate of small blue cells throughout the biopsy specimen.
|
Case 4 - Figure 2
Closer view confirms the nodular architecture and cells appear to be lymphoid.
|
Case 4 - Figure 3
Lymphocytes consist of a small to medium size population.
|
Case 4 - Figure 7 - CD3
CD3 highlights small admixed lymphocytes.
|
Case 4 - Figure 8 - CD20
CD20 highlights most of the infiltrate including atypical lymphocytes.
|
Case 4 - Figure 9 - EBER
In-situ hybridization reveals nuclear positivity for EBER in many of the large atypical lymphocytes.
|
for Text and References
Submitted by: Alexander Lazar
Female age 52 with a 1 cm pruritic papule on right breast present for at least 2 months. The raised surface is smooth and erythematous. Clinical assessment was an "infiltrative process."
Case 5 - Slide 1
|
Case 5 - Figure 1
A nodular infiltrate is present in the dermis, 20x.
|
Case 5 - Figure 2
The infiltrate is composed of a mixture of lymphocytes and histiocytes surrounding small vessels, 200x.
|
Case 5 - Figure 3
Larger forms are admixed in the infiltrate, 400x.
|
Case 5 - Figure 4 - CD30
CD30-positive forms represent around 5 % of the infiltrate, 100x.
|
Case 5 - Figure 5 - CD30
The CD30-positive forms occur as single cells and small clusters, 400x.
|
for Text and References
Submitted by: Alexander Lazar
Female age 36 with an erythematous nodule on the shoulder present for "some months". The clinical assessment was possible pyogenic granuloma.
Case 6 - Slide 1
|
for Text and References
Submitted by: Kim M. Hiatt
An 87 year old man with gout began taking allopurinol 3 months prior to presentation. At presentation he has blanchable, erythematous macules coalescing into patches over trunck and extremities. The clinical impression is drug hypersensitivity vs CTCL.
Case 7 - Slide 1
|
Case 7 - Figure 1
This low power image shows a dense lichenoid infiltrate with only minimal involvement of the superficial dermal vessels. This infiltrate has a CD3+/CD4+ predominance.
|
Case 7 - Figure 2
Higher power reveals the epidermotropic infiltrate is composed of lymphocytes with enlarged nuclei and irregular nuclear contours. The perinuclear halo results from fixation-associated retraction of the atypical lymphocytes with abundant cytoplasm. In particular at the tips of the rete, the lymphocytes are seen aligned along the basilar keratinocytes. Notably, spongiosis, dyskeratosis, hyperkeratosis and parakeratosis are not present.
|
Case 7 - Figure 3
The nuclear atypia is more apparent at this higher power. In addition to the atypical lymphocytes with perinuclear halos seen aligned along the basilar layer, collections of intraepidermal atypical lymphocytes, Pautrier microabscesses, are also noted.
|
for Text and References
Submitted by: Kim M. Hiatt
A 80 year old man returns to the dermatologist for the third time for evaluation of a nodule on the arm. The previous biopsy showed cutaneous lymphoid hyperplasia.
Case 8 - Slide 1
|
Case 8 - Figure 1
A dense dermal infiltrate with a vaguely nodular pattern is appreciated in this low power image. There is perifollicular and periadnexal involvement by this infiltrate.
|
Case 8 - Figure 2
The mixed lympho-histiocytic nature of the infiltrate is noted at this higher power. Immunohistochemical staining reveals the cells with small hyperchromatic nuclei as well as some of the larger cells with open chromatin to be lymphocytes. There is mixed CD4+ and CD8+ expression in these lymphocytes. All these features support the reactive nature of the infiltrate.
|
Case 8 - Figure 3
This higher power image confirms the heterogeneous population in this dermal infiltrate to be predominantly lymphocytes, histiocytes and plasma cells, along with plump endothelial cells. These features further support the reactive nature of this infiltrate.
|
|
|
|
|
Click to view with ImageScope
Click to view with a Web-Based Viewer
