M/28yrs/Asian, A known case of CTCL( cutaneous T-cell lymphoma)  
Outside skin bx report on 8/12/06: focal monotonous infiltrate in the dermis, extending to the epidermis, positive for LCA, CD45 RO and negative for CD20, Dx: possibility of CTCL cannot be excluded.  
Already on rePUVA ( Neotigasone + PUVA) x 5 months( 3sessions of PUVA/wk)  
O/E: multiple skin lesions over back + abdomen, papules to nodules, size about 0.2 to 1.5 cm in diameter, clinical dx: CTCL  

SergeyN 2007-07-18 09:11	Mycosis fungoides seems most probable (except for a bit too much of dyskeratosis). What was the site of the biopsy?
Mueller-Hermelink 2007-07-18 11:30	Phenotyping is necessary ( can be everything from acute leucemia, hematodermic neoplasia to malignant lymphoma),but does not look suggestive of mycosis fungoides.
munafdesai 2007-07-19 21:27	Bx is taken from lower back.
SergeyN 2007-07-21 09:03	It could be a good idea to upload the CD45RO images, including the intraepithelial infiltrates. Could you stain for CD3 as well? Are CD20+ cells completely abscent?
schulze 2007-07-23 11:11	Only mild psoriasiform hyperplasia (patient is on therapy), but diffus, bandlike dermal infiltrate of small, variable atypical hyperchromatic lymphocytes with focal epidermotropism, highly suggestive for mycosis fungoides, eczema type (during treatment). Dyskeratotic cells in the epidermis seem to reflect UV-radiation induced apoptosis of PUVA therapy.
hurwitz 2007-07-29 20:05	In view of the clinical appearances (multiple papules and nodules in areas not exposed to the sun) and the histologic findings,   the diagnosis of mucosis fungoides (Dr.Schulze) seems to be the most probable one.
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