Cutaneous T-Cell Lymphoma: Clues to Diagnosis in Early Lesions
The correct identification of cutaneous T-cell lymphomas and their differentiation from both inflammatory dermatoses and reactive lymphoid hyperplasias represent a vexing problem when dealing with the initial phases of a lymphomatous process. Even advanced diagnostic techniques, like immunophenotyping, quantitative DNA cytophotometry, and molecular genetic analysis, have proven to be unsuitable for solving the problem; thus, light microscopy remains the basic, gold standard diagnostic procedure. In order to make a definite diagnosis of lymphoma from early lesions, the most important and cardinal feature is the presence of lymphocytes with extremely convoluted (cerebriform), medium-large-sized (7–9 μm) nuclei (medium-large cerebriform celis), singly or in clusters in the epidermis and in discrete collections in the dermis. Additional histologic features are: (i) epidermotropism, manifested as single cells lining up along the basal keratinocytes near the dermal-epidermal junction; (ii) tendency of medium-large cerebriform cells within the epidermis to congregate and seemingly to touch one another; (iii) absence of spongiotic microvesiculation; (iv) little or no edema of the papillary dermis; slight to moderate fibrosis in some cases; and (v) a tendency of the dermal infiltrate, which as a rule is rather monomorphous in composition, to assume a lichenoid configuration.
KeywordsLymphoma Shrinkage Convolution Hematoxylin Eosin
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