Papular exulcerated lesion was removed from the hand of 67yrs old male. Clin.dgn.: nevus with exulceration.  
Histo: The top heavy wedge shaped infiltrate with large amount medium- large cells with vesiculated and lobated nuclei and prominent nucleoli in the background of small lympho's, eo's, etc.  
Immuno: large cells CD30+; ALK1-; EMA+ (foc. dim.);  
LAST IH: giant cells: CD4/CD8/CD5/GranzymB(-),CD15(-). GranzymB+ cells are few and small; CD4+ cells are numerous, but with regular nuclei. Single S100 and CD1a+ Lang cells in dermis.  
Proposed diagnosis: Lyp (type A) >>> primary ALCL.  
Thank you for comments. A lot of excusses for GranzymB photo.

dirnhofer 2005-12-08 15:14	this is a cd30+ cutaneous lymphoprolif; morphologically would favour alcl but def dx depends on clinical features (spontaneous resolution of lesions etc)
ugnius 2005-12-08 15:25	Thanx. Some T stains are ordered additionaly.
franco 2005-12-08 15:26	i agree with s. dirnhofer; cutaneos alcl.
kunze 2005-12-09 10:39	I agree to the diagnosis of a CD30-positive cutaneous lymphoproliferative disease. IHC should be completed by T-cell markers, CD15 and cytotoxic molecules.
hurwitz 2005-12-11 20:20	I agre with my collegues, this is a CD30+ cutaneous lymphoproliferation, I also favour primary cutaneous ALCL over type A Lyp. This is supported by the clinical appearance (solitary lesion).
ugnius 2005-12-22 19:47	Thank you all.
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