We present here a new case of enlarged right inguinal lymph node that was extirpated in a 47-year-old Bosnian male. He has been diagnozed with Mycosis fungoides seven years ago (patch phase).  
The yellowish, soft lymph node measured 3.5x1 cm.  
Microscopically, architecture of the lymph node was mainly preserved. In interfollicular areas, we noticed the presence of foamy cells filled with a dark pigment along with eosinophils and plasma cells.  
No signs of the spread of mycosis fungoides to the lymph node.  
Special staining: Fontana (positive).  
Immunohistochemistry: CD1a (positive), S100 (positive within the dendritic cells).  
Clinically, no signs of the spread of mycosis fungoides.  
Histopathological diagnosis: Langerhans hystiocytosis, reactive changes  
or other entity unrelated to the primary disease?

Mueller-Hermelink 2007-08-14 13:42	There are two alterations that need mentioning : 1.Increase of epithelioid venules and Eosinophilia in a pattern that could be suggestive for Kimura's disease or a hypersinsitivity assaciated lymphadenopathy, in particular as no atypias in the distribution or structure of the lymph node are seen in these pictures, and 2) melanin pigment containing macrophages and increase of Langerhans cells that are an usual element of dermatopathic lymphadenopathy and certainly reactive( the old german term for dermatopathic LA has been lipomelanotic reticulosis) .The differential diagnosis of the first alteration is of course focal involvement by T cell lymphoma which should be further excluded by TCR rearrangement and additional IHC ( T cell subtyping , Ki 67,, capsule involvement and FDC stain).
hurwitz 2007-08-15 16:29	Looking at the images without considering the clinical information of mycosis fungoides 7 years ago, I would think that this is a typical case od dermatopathic lymphadenitis and inquire if there is any evidence of a dermatologic affection at present. Regarding the previous diagnosis of MF, could you please find out what was the basis for this diagnosis? If a skin biopsy has been performed, could you get it and add the images to the case?
dirnhofer 2007-08-16 18:27	basically, i would favor dermatopathic la (accompanied by hypersensitivity assoc changes); if in doubt clinically or morphologically on other regions of the ln, special stains and molpath as suggested by prof müller-hermelink to rule out focal t-nhl should be performed; although on the slides provided i do not consider t-nhl present.
SergeyN 2007-08-16 20:15	Are there skin changes now?     If there are, dermatopathic lymphadenopathy seems to be the first diagnosis to consider. If there are none, increase of melanin-containing macrophages must be explained somehow.
hurwitz 2007-08-26 19:38	Summary: Dermatopathic lymphadenitis.   Recommendation: rule out focal involvement by T-NHL TCR rearrangement.
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