S13C7P5-1: The classic primary T-cell neoplasias are commonly spoken of, and classified as,  cutaneous T-cell lymphomas. They are then managed as if the distinctions between the lymphocytic (i.e., small cell) variants and the large-cell variants are of no importance; instead, emphasis is placed on clinical stage. For most examples, the small cell (lymphocytic) variants are properly characterized as borderline lesions; it is difficult to predict rate of progression, or even be confident of an inevitable progression to a higher grade of neoplasia. In this field, the distribution of the infiltrate is characteristic of that seen in the evolving (pretumoral) stages of a cutaneous T-cell dysplasia; the cells are mostly confined to a widened papillary dermis with variable representation in the overlying epidermis. Individual lesions of the borderline T-cell dysplasias tend to have a long life history. For some examples, cellular phases may give way to less cellular patterns; old lesions may be sparsely cellular with papillary dermal fibrosis and telangiectasia (the changes then take on a poikilodermatous quality). Some examples in the cellular phase have distinct lichenoid qualities; other examples, as in this field, are psoriasiform. In fact, this lesion in the 1960’s was diagnosed by a renowned dermatopathologist as “ostraceous” psoriasis.

S13C7P5-2: Elongated rete ridges are represented centrally and to the right. The lymphoid cells of the intra-epidermal infiltrates have enlarged nuclei that are irregular in outline; the nuclei are enlarged (cells are transformed), but the cells have not acquired the features of a large-cell lymphoma. An elongated, edematous papilla extends upward on the left. At its extremity, there are lytic defects at the dermal-epidermal interface; lymphocytes, histiocytes, and one necrotic keratinocyte are present in the defect. There are loosely spaced, necrotic keratinocytes in the neighboring, elongated rete ridge. The lesion has both lichenoid and psoriasiform qualities. The nuclei of the lymphoid cells in the epidermis are larger than the nuclei of the lymphocytes of the dermal infiltrates; this is a common, but not universal, characteristic of most mild to moderate T-cell dysplasias.

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S13C7P5-4: Green arrows identify cells with distinctive nuclear characteristics in the infiltrates of the papillary dermis. These nuclear changes are more extreme than those usually associated with reactive processes; lymphoid cells with convoluted nuclei are common in reactive processes (Lutzner cells). Reactive processes often are associated with a high component of transformed lymphocytes, but the nuclei of such cells generally are small. In reactive processes with a high component of “Lutzner” cells, the patterns would additionally qualify as a mild T-cell dysplasia (a morphologic designation rather than an “at risk” assessment) of indeterminate type.