S4C22P14PLCDysplasia


S4C22P14-1: This pattern is clearly lichenoid at the dermal-epidermal interface; it might be additionally qualified as mixed primary and established type. There is basal unit hyperplasia which provides “psoriasiform” qualities; the pattern of an established lichenoid reaction focally is represented. The superficial unit is somewhat hyperplastic with a prominent granular layer. The dermal infiltrates are band-like in the papillary dermis ( CTCL; La Derm-8514).


S4C22P14-2: In this area, the number of cells per unit area sets the epidermal pattern apart from a common spongiotic process. The patterns are cytolytic with relatively few necrotic keratinocytes. The superficial unit is hyperplastic and the neighboring basal unit is hyperplastic. The patterns have a pityriasic quality. The cells of the epidermal infiltrate have small nuclei, but there is some variation in nuclear outlines. Some observers, simply on the basis of both the number of lymphoid cell in the epidermis and the rather monotonous character of the epidermal infiltrates, would characterize the lesion as cutaneous T cell lymphoma (CTCL). This is a convenience which begs the question of the biologic significance of the infiltrate. This was a process clinically compatible with childhood CTCL; follow-up of such cases has not been significant in offering strong support for the malignancy of the process. Lesions of this type are mostly histologic, rather than biologic, “lymphomas.” The histologic similarities to childhood PLC are obvious.

S4C22P14-3: This is another example of childhood “CTCL” (La Derm-8515). There is a band-like infiltrate of lymphoid cells in a widened papillary dermis. The epidermal pattern is psoriasiform with accentuation of the rete patterns. Some of the rete ridges are thin and have pointed extremities (a lichen planus-like quality). The infiltrates are loose, but diffuse in the papillary dermis. There are minimal, perivenular infiltrates in the upper portion of the dermis.

S4C22P14-4: This second case of “childhood CTCL” shows lichenoid and psoriasiform pattens, a combination that qualifies as pityriasic.

S4C22P14-5: This cell-rich pattern, with a high component of small, atypical lymphoid cells per unit area in the epidermis, is often cited as sufficient to establish a diagnosis of CTCL. The basic patterns are pityriasic and are more extreme than those seen in the two cases of childhood PLC (there are,however, similarities, both in patterns and cytologic features).

S4C22P14-6: The richness of the infiltrates in the epidermal domain would, for many observers, justify a diagnosis of CTCL regardless of the degree of cytologic atypia (some observers cannot appreciate degrees of cytologic atypia). The lymphoid cells are not associated with a high component of histiocytes; necrotic keratinocytes are not a prominent feature. Focally, the basal unit is better preserved and is hyperplastic. The patterns in these two cases differ from those in the two cases of PLC by the diffuseness of the infiltrates in the dermis and the density of the atypical cells per unit area in the epidermis. Other than that, the cells are cytologically similar. The pattens in these two cases of “childhood CTCL” qualify as T cell dysplasia of indeterminate malignant potential, childhood variant. The patterns are pityriasic (lichenoid patterns with irregular basal unit hyperplasia).

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