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?
Part (A) reproduced, with permission, from Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill Education; 2013.