eISSN: 2084-9869
ISSN: 1233-9687
Polish Journal of Pathology
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1/2013
vol. 64
 
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Quiz. What is your diagnosis?

Online publish date: 2013/04/25
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QUIZ

WHAT IS YOUR DIAGNOSIS?



A 17-year-old girl presented with a 7-year history of progressive and coalescent purpuric, pigmented, non-pruritic macules (Fig. 1). The first skin biopsy taken in 2007 showed hyperkeratotic epidermis, slightly dilated capillaries and mild lymphocytic infiltrates with granulomas in the papillary dermis (Fig. 2).

After a 16-month follow-up, a second skin biopsy revealed a dense, band-like lymphohistiocytic infiltrate, occupying the papillary and upper reticular dermis, composed of small, mildly atypical cells; single cells migrated into the epidermis (Figs. 3, 4). The lymphocytes were CD3+, CD4+, CD8+, with a CD4 : CD8 ratio of 2 : 1, and a 30% reduction of CD7 expression. Granulomatous reaction and hemosiderin deposits were also present (Fig. 5).

Due to apparent disease progression three months later, a third biopsy was taken; the histological picture was similar to the second biopsy, but the density of the lymphocytic infiltrate slightly decreased. TCR gene rearrangement analysis revealed an oligoclonal T-cell population.
Copyright: © 2013 Polish Association of Pathologists and the Polish Branch of the International Academy of Pathology This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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