Answer to Image of the Month August 2013
Submitted by Rajalakshmi T, Inchara YK
Image C.
The other three images represent inflammatory diseases while C shows a neoplasm - mycosis fungoides.
Explanation:
All the four images provided share a common pattern, i.e. psoriasiform acanthosis.
Image A shows zones of parakeratosis, diminished granular layer, mild spongiosis, suprapapillary thinning and tortuous dermal capillaries with a dermal lymphocytic infiltrate. This is psoriasis.
Image B shows compact orthokeratosis, low papillomatosis, hypergranulosis, thick rete pegs and vertical streaks of collagen in the papillary dermis, characteristic of lichen simplex chronicus.
Image D shows scale crust with much serum, spongiosis with lymphocytes and a moderate dermal lymphocytic infiltrate. These findings are consistent with allergic contact/nummular dermatitis.
Image C shows parakeratosis, disproportionare epidermotropism of lymphocytes, basilar tagging, a dense dermal lymphocytic infiltrate and dermal papillae stuffed with these cells. These features are consistent with mycosis fungoides, patch stage.