PMC7132347_01
Showing photodistributed erythema (a, b) and massively infiltrated papulous plaques on the face and neck (b) of a patient with actinic reticuloid. Skin biopsy taken from the cheek (c) showing acanthosis and a diffuse lymphocytic infiltrate in the entire dermis. There was no evident epidermotropism of the T cell dominant infiltrate leading to the diagnosis of pseudolymphoma (d). A biopsy taken from eczematous lesions on the trunk (b) showing acanthosis with focal parakeratosis, thickened collagen bundles (>>), and a sparse, mainly lymphocytic infiltrate with hyperchromatic cells (<) in the upper dermis (e). Together, the histologic picture and clinicopathological correlation matched the diagnosis of actinic reticuloid.
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fig1
However, the grade of infiltration and induration of skin lesions had significantly increased including impressive tumor-like aggregated papules and nodes mainly affecting the sun-exposed areas (Figure 1). T cell dominant infiltrate, resulting in the histologic diagnosis of pseudolymphoma (Figure 1). T cell receptor (TCR) rearrangement was negative.
MED testing in a patient with actinic reticuloid showing increased photosensitivity both in the UV-B and UV-A range.
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fig2
Twenty-four hours after irradiation (Figure 2), the phototest revealed markedly reduced MEDs both for UV-B (<8 mJ/cm2) and UV-A (0.9 J/cm2) based on previously established lower reference limits of 33 mJ/cm2 and 12.6 J/cm2, respectively.
Clinical picture of a histology-proven primary cutaneous anaplastic large T cell lymphoma on the upper right arm (a). CD30 immunohistochemistry showing sheet-like lymphocytic infiltrates of large T cells, which were almost exclusively CD30+ (b, c), consistent with a diagnosis of cutaneous anaplastic large T cell lymphoma.
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fig3
Again, histology and immunohistochemistry confirmed the diagnosis of C-ALCL (Figure 3).