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Case 127 - Discussion

Hematopathology Case

 

Dermatopathic Lymphadenopathy

  • Reactive paracortical hyperplasia with an increased number of interdigitating dendritic cells, Langerhans cells, and histiocytes with cytoplasmic melanin deposits and lipid vacuoles.

  • Mostly axillary and inguinal lymph nodes. Associated with skin lesion.

  • Micro:

    • Architecture preserved

    • Paracortical expansion, pale confluent areas

    • Increased histiocytes, interdigitating dendritic cells (S100+, CD1a-), and Langerhans cells (S100+, CD1a+)

    • Phagocytic histiocytes with lipid, melanin, or less often hemosiderin

    • Follicular hyperplasia present in early stage

  • DDX: mycosis fungoides and SÚzary syndrome involving lymph node - similar morphology, partially or totally obliterated architecture, flow cytometry or molecular studies for TRG@ rearrangement necessary

Reference: Ioachim's Lymph Node Pathology, 4th edition