Woman 79yrs old presents with 6 month's nonhealing forehead skin ulcer.  
CLIN.DGN.: Basal cell carcinoma.  
HISTO: Skin ulcer with large areas of necrosis. There is the diffuse dermal infiltrate spreading to subcutaneous fat consisting of small- medium sized lympho's (T) with large amount of eosinophils and histyocytes. The epidermothropism and adnexothropism are present (CD4+ cells). The tears of necrosis with pmn's in dermal infiltrate. There are mitoses nad atypical forms in the infiltrate.  
IMMUNO (in progress): CD4+>>CD8+, CD45RO+(100%), GranzymB+/- (20%), CD56+/- (5%), CD3+(dim)60%, admixture of single CD30+ large cells.  
PROPOSED DIAGNOSIS: Cutaneous CD4+ T cell lymphoma. Variant after EORTC: primary cutaneous small/medium pleomorphic T cell lymphoma??? Perpheral T lymphoma NOS???  
Thank you for comments.

hurwitz 2005-11-28 19:35	There is definitvely a cutaneous infiltrate by T-cell lymphoma, small medium sized cells CD4+. The appearances are consistent with a primary cutaneous T-cell lymphoma, however to exclude peripheral T-cell lymphoma NOS, I would like to have more clinical information.
ugnius 2005-11-29 09:07	Additional info: The itching cutaneous infiltrate appears 6 moths defore. After traumatisation the infiltrate progress to the exulceration not responding to antibiotic treatment. There are any signs of lymphadenopathy nad B symptoms. The similar infiltrate appears a week before in the bridge of the nose.   The process seems to be primary in skin.
hurwitz 2005-11-29 09:41	With this information we are probably dealing with a primary cutaneous lymphoma.
ugnius 2005-11-29 10:08	Thank you for urgent comments. Your compliments was readressed for my bosses:)
Went 2005-12-06 09:40	Without a history (this is an excluding criteria) of patches and plaques and without other manifestations of an NHL, this tumor can be classified as "prim. cutaneous CD4+ small/medium sized pleomorphic T-cell-lymphoma" (provisional entity of the WHO/EORTC classification), as it fulfilles exemplaril.y all the necessary criteria.
ugnius 2005-12-06 09:56	Many thanx. Looking to the future cases.
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