MEETING No. 26, DECEMBER, 13rd, 2000, SAN CARLO HOSPITAL, MILANO

Case 1
Case 2
Case 3
Case 4
Case 5

Case 1

"SKIN SPOTS ON THE BACK"
M. LUCIONI, C. DEL FORNO, R. ROSSO, M. PAULLI - S. Matteo Hospital, Pavia


Clinical history: in July 1999 a 66y.o. woman underwent a skin biopsy in another hospital and a diagnosis of “mycosis fungoides” was made.
In October 2000 she came to the dermatological department of the S. Matteo Hospital for the presence on the back and the chest, since 2 years before, of erythematous, infiltrative, recurrent skin lesions with centrifuge extension (pict. 1).
Blood tests were all normal. A skin biopsy was performed. Microscopic description: in the dermis there is a moderate, mainly peri-vascular lymphoid infiltrate, which contains a few histiocytes and which does not seem to involve the epidermis. The papillary dermis appears mildly edematous. There are no spongiosis, para-keratosis, hyperkeratosis or basal layer alterations (pict. 2) - (pict. 3) - (pict. 4).
Immunohistochemical staining results: the cell population prevalently consists of CD21 (pict. 5), CD3 and MT1/CD43 positive small T lymphocytes there are a few PGM1/CD68 positive histiocytes/macrophages (pict. 6) there are few L26/CD20cy and CD79a positive B lymphocytes (pict. 7).
Blood test examination:

• direct immunofluorescence for IgG, IgA, IgM, complement and fibrinogen is negative
• Borrelia Burgdorferi serology is negative
• Anti-nucleus and anti-ENA antibodies are absent

Differential diagnosis:

• Jessner-Kanof lymphocytic infiltrate
• Lupus Erythematous
• Deep Erythema Gyratum
• Chronic Erythema Migrans (Lyme disease)
• Erythema Gyratum Repens
• Skin lymphoma

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7

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