S13C10aP8a-3: At higher magnification, there is some variability in nuclear size but, cytologically, this is a large cell neoplasm of lymphoid type. By history, the process had been remittent. It something of a stretch to classify this as something other than lymphoma but, in the face of the clinical course, the lesion should be characterized as a lymphoproliferative lesion. A variant of lymphomatoid papulosis should be mentioned in the differential diagnosis.

S13C10aP8a-4: Nuclei are enlarged and hyperchromatic; they vary in size and outline.There is a mitotic figure below the center of the field.

S13C10aP8a-5: This lymphoid lesion is most prominent in the pattern of islands of lymphoid cells among follicles in the upper portion of the reticular dermis. A grenz zone separates the epidermis and the follicular epithelium from the lymphoid infiltrates. Beneath this portion of the lesion, the infiltrates are perivascular. The tissue of the grenz zone is abnormal fibrous tissue; it is densely fibrous and hyalinized. About the follicles, it is laminated. The patterns in which the infiltrates are distributed find some accommodation in the parcels defining granuloma faciale (i.e., there is an insular quality at this magnification). On the other hand, the lesion is too clearly lymphoid to be dismissed as granuloma faciale. The infiltrates can be accommodated in the category of atypical lymphoplasia (a borderline lymphoproliferative category providing refuge for a variety of lymphoid hyperplasias of the skin) .

S13C10aP8a-6: The patterns are basically the same as those seen in S13C10aP8a-5. Islands of lymphoid tissue sit in the upper portion of the reticular dermis among follicles. The defect in the follicle to the left is a technical artefact. The dermis beneath the insular components shows solar elastosis (atypical cutaneous lymphoplasia - lymphoplasmocytic variant) (continued on next page (chapter) in sequence).