MEETING N. 27, JANUARY 17th, 2001, ISTITUTO NAZIONALE TUMORI, MILANO

Case 1
Case 2
Case 3
Case 4

Case 3

"A GROWING SKIN NODULE"
M. PAULLI, M. LUCIONI, F. PASSAMONTI - Anat. Pathol. And Haematology. Depts. S. Matteo H., Pavia
(Pictures by dr. Paulli)

Clinical history: a 78y.o.man presents in November 1999 with a 1 cm sub-clavicular, itchy, whitish skin nodule; there is no ulceration and the patient does not refer pain.
In April 2000 during a dermatological follow up the lesion appears greatly enlarged (5 cm), ulcerated and white-reddish in colour (pict. 1).
The previous clinical history is negative; there are no systemic symptoms. A punch biopsy of the lesion is performed.
Microscopic description: there is a dermal-hypodermal infiltrate consisting of lymphocytes, eosinophils, histiocytes, large Hodgkin and Reed-Sternberg like cells (pict. 2) - (pict. 3) - (pict. 4).
The overlying epidermis shows marked pseudo-epitheliomatous hyperplasia. The large cells are positive with immunohistochemical staining for CD15 (pict. 5) and CD30 (pict. 6) and show dubious stain for EMA; they are negative for TIA-1 (pict. 7)and ALK.
Molecular biology: non-B, non-T cells.
Differential diagnosis:

• CD30 positive, primary skin lymphoma
• Borderline lesion between lymphomatoid papulosis and ALCL (C type Lyp)
• (primary?) Skin localization of classic Hodgkin lymphoma

Diagnosis

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

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