S13C8P6-1: In the category of T-cell dysplasia-neoplasia, lymphomatoid papulosis is classically a perivenular process with variable epidermal components. In this example, the epidermis shows hyperplasia of the basal unit, but epidermal infiltrates of lymphoid cells are not a significant feature. Vessels have thickened walls and swollen endothelium (margination of neutrophils along the endothelial surface of vessels is sometimes a prominent feature). The perivascular infiltrates are dense and polymorphic. Lymphoid cells, some of which are atypical with enlarged, hyperchromatic nuclei, extend into the reticular dermis among collagen bundles (a pattern characterized as “lumps of coal”). The lesion has vasculitic qualities; there are collections of extravasated red blood cells.

S13C8P6-2: At higher magnification, the perivascular infiltrates are polymorphic. They contain a high component of atypical cells with eccentric nuclei and pale, or lavender, cytoplasm. The nuclei of the large cells vary in size and outline; chromatin patterns are dense. Cells with nuclear characteristics of this type have been compared to “lumps of coal.” Rather loose infiltrates of similar cells extend into the reticular dermis among the collagen bundles. Some of the cells are binucleated. The pallor of collagen bundles is a technical artifact - a quality of the stain.

S13C8P6-3: The atypical cells have blast-like qualities. Some show a perinuclear halo or hof. There is a mitotic figure near the top of the field. The large cells in the interstitium of the reticular dermis have been compared to “lumps of coal.”

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S13C8P6-5: Red arrows point to variants of large, transformed T-cells. In the proper clinical and histologic setting, the cells would be diagnostic of a T-cell lymphoma. In this histologic and clinical setting (history of spontaneous regression of lesions), the large cells are acceptable in the parcel of virtual images that relate to lymphomatoid papulosis. Green arrows identify a vessel with swollen endothelium. The two neutrophils in the lumen might be cited as evidence of margination of leukocytes.