27 yrs old woman presents with multiple confluent painless nodules in skin (breast, back, trunck, buttocks). Excisional biopsy was performed (consultation case).
HISTO: Irregular confluent nodular perivascular and periadnexal dermal infiltrate consist of small- medium lymphocytes with irregular, wrincled, cleaved nuclei (T) and admixture of histyocytes and eosinophils. The epidermothropism, adnexothropism are absent (single CD3+ cells in epidermis). Mitoses and atypical forms are present. Exulceration is present. The infiltrate is irregular wedge shaped with basis in upper part.
IMMUNOHISTO (in progress): CD3+ infiltrate with mixture CD4+, CD8+ cells (ratio CD4/CD8 about 3-4/1), CD68+ macrophages. There are some CD56+ cells or CD30+ interstitial large cells. The multinucleated HL like cells are absent.
PROPOSED DIAGNOSIS 1: Cutaneous T pseudolymphoma (drugs? insect bites?) >>> cutaneous T lymphoma?.
PROPOSED DIAGNOSIS AFTER IH 2: Langerhans' cell histiocytosis?
Thank you for comments in advance.
FINAL DRAFT DIAGNOSIS: T pseudolymphoma with reactive LCH-like lession?