PITYRIASIS LICHENOIDES ET VARIOLIFORMIS ACUTA with minimal lymphocyte atypia (biopsy #2) from a patient who has LYMPHOMATOID PAPULOSIS (biopsy #1)
The salient features of the possible relationship of pityriasis lichenoides et varioliformis acuta to lymphomatoid papulosis is mentioned in the discussion of biopsy #1.

Keratinocyte enlargement, focal parakeratosis, necrotic (apoptotic) keratinocytes, vacuolar change in the basal layer of the epidermis, extravasated red blood cells, and the presence of holes in the keratinocytes (some of which contain lymphocytes) are features of pityriasis lichenoides. Protracted search was required to find a few atypical lymphocytes. Marker studies have not been done on this case.


These pictures are from another biopsy done at the same time on the same patient described for CASE #1 for the Dermatopathology Conference of 01/04/02. For review,  this is an 8 year old child who developed multiple erythematous papules on the trunk and extremities, some of which had a crust. The clinical impression was pityriasis lichenoides et varioliformis acuta. This biopsy is from one of the early lesions that had not developed a crust.

The atypical cells that were so prominent in biopsy #1 are very few in number in this biopsy.
 
Medium power view of an area showing a few necrotic (apoptotic) keratinocytes within the epidermis, keratinocyte enlargement, holes in some of the keratinocytes, liquefaction (vacuolar) change at the dermoepidermal junction, and lymphocytes that are not atypical. Parakeratosis is also seen.
High power of above. The lymphocytes are small and are not atypical.
A medium power view from an area showing extravasation of red blood cells into the epidermis.
A high power area from a section that was thinner than most of the others. This shows some of the few atypical lymphocytes (AL) found on this slide.

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