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.