80 yrs woman presents with tumor like nipple- megaly without ulceration. Resection was performed due to clinical diagnosis "Paget's disease".  
HISTO: The infiltrate in dermis (with clear Grenz zone) consists of diffuse small lymhocytes with residual lymphoid follicles in the deep of infiltrate. Cytology of cells: ovoid, slightly irregular nuclei and minimal clear cytoplasm. There are single plasma cells in infiltrate. There is slight syringothropism of lymphocytes.  
IMMUNO: CD20+, CD43+, Bcl2+, CD23-/+ (some cells <5% and plasmacytes focally), CD10/Bcl 6-, CyclinD1-.  
Germinal centres of follicles: CD10+, Bcl6+, Bcl2-. Some with irregular contour, maybe colonized.  
PROPOSED DGN.: Cutaneous B marginal zone lymphoma. Very strong CD43+ and focal CD23 positivity?  
Thank you in advance for comments.  

franco 2005-11-20 15:24	Morphology and immunohistochemistry are consistent with the proposed interpretion of marginal zone B cell lymphoma, in skin. To confirm the primary cutaneous nature of the lymphomatous neoplasm, exclusion of other site(s) of disease is recommended.
ugnius 2005-11-20 15:34	Thank you, dr. Franco. Architecture of infiltrate fulfils all criteria of MZL, but CD43+ and faintly 23+ in some cells are a little bit confusing and CLL version is considered. The full hematological evaluation (blood, flow, etc.) is recomended. Sometimes in classic CLL CD23 positivity is very faint and ambigous in our lab., especially in bone marrow.   There are only few plasmacytes and "naked" follicle centers without clear signs of colonisation.
hurwitz 2005-11-28 20:47	Both the infiltration pattern and the immunophenotype are consistent with marginal zone B-cell lymphoma. The faint CD23 positivty is unusual, but not enough to consider CLL. An Incubation with CD5 could help to dicriminate between marginal zone lymphoma and CLL.
ugnius 2005-11-29 08:08	Thank you for help.
Went 2005-12-06 09:51	Altough morphology and immunophenotype are suggestive for marginal zone lymphoma, CD23+ is unusual and I would also suggest a CD5 (altough we recently saw several marginal zone lymphomas with CD5 positivity, most of them of splenic origin). As always, the primary cutaneous nature of the disease has to be confirmed by clinical exminations.
ugnius 2005-12-06 10:42	Thank you dear dr.Went. CD5 is not working very well in our lab, so it's very difficult to obtain critical results. CD23+ was only focal and histological picture is still different from CLL.
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