A biopsy of a scaly plaque is reported to show both epidermotropism of atypical lymphocytes and prominent spongiosis with spongiotic vesicles containing Langerhans cells. Which additional finding on routine H and E sections would MOST strongly favour mycosis fungoides over chronic spongiotic dermatitis?
- A Parakeratosis with retained nuclei in the stratum corneum
- B Pautrier microabscesses formed by atypical cerebriform lymphocytes without significant associated spongiosis ✓
- C Wedge-shaped hypergranulosis with basal cell vacuolisation
- D Neutrophilic microabscesses in the stratum corneum
Correct answer: B. Pautrier microabscesses formed by atypical cerebriform lymphocytes without significant associated spongiosis
Explanation
The hallmark of mycosis fungoides is epidermotropism of atypical hyperchromatic lymphocytes with convoluted cerebriform nuclei, including intraepidermal collections (Pautrier microabscesses) occurring out of proportion to spongiosis. Spongiosis with Langerhans cell vesicles favours eczematous dermatitis. Parakeratosis occurs in psoriasis and spongiotic eruptions, wedge-shaped hypergranulosis indicates lichen planus, and neutrophilic horn microabscesses indicate psoriasis.
Reference: McKee's Pathology of the Skin, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.