Chapter 12: Lymphoid, Leukemic, and Other Cellular Infiltrates

QUESTIONS

QUESTION 12-1. Which general statement regarding T-cell pseudolymphoma is INCORRECT?

A) These lesions both clinically and histopathologically may resemble mycosis fungoides and may occasionally exhibit clonality via T-cell-receptor rearrangement analysis.

B) The natural history of T-cell pseudolymphoma is that of a chronic dermatosis that either transforms into lymphoma or eventually resolves spontaneously.

C) These lesions may be histopathologically characterized by nodular dermal infiltrates with scattered large CD30+ T cells.

D) T-cell pseudolymphoma is immunohistochemically defined by lost expression of pan-T-cell markers CD2, CD5, or CD7.

E) Reported associations include HIV disease, UV-light exposure, and various medications.

QUESTION 12-2. A 66-year-old Caucasian male presents with irregular, well-circumscribed, confluent, yellowish-red patches with slight scaling on the trunk or buttocks. The lesions have been present for over 10 years. A biopsy is performed and the findings are illustrated below. Immunohistochemical staining reveals the infiltrate to be composed predominantly of CD3+, CD2+, and BF1+ T cells. The intraepidermal CD4 to CD8 ratio is 4:1 and the dermal CD4 to CD8 ratio is 10:1. There is preserved expression of CD5; however, there is a marked reduction in CD7 expression in the realm of 90%. Which of the following statements regarding this patient’s condition is INCORRECT?

A) This patient has the d’emblée form of mycosis fungoides.

B) High-power examination will reveal the infiltrate to be composed predominantly of small lymphocytes with cerebriform nuclei.

C) This condition has a propensity to involve sun-protected sites such as the trunk or buttocks.

D) These patches will gradually progress to plaques and/or nodular tumors.

E) These lesions frequently contain intraepidermal clusters of lymphocytes without Langerhans cells.

QUESTION 12-3. A 65-year-old male presents with plate-like thickening of the skin on the neck and chest and loose poikilodermatous folds in the axillary and scapular areas. A biopsy of the loose skin is performed and the findings are illustrated below. Immunohistochemistry reveals the small lymphoid cells to be of the CD3+, CD4+, CD8−, CD30− T-helper phenotype. The giant cells express CD163, lysozyme, and CD68. Elastic stain reveals a marked reduction of elastic fibers in the dermis. Fragmented elastic fibers are identified within the multinucleated giant cells. T-cell-receptor rearrangement analysis reveals clonality. Which of the following diagnoses is CORRECT?