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.