Hong Wu, Mitchell Smith, Michael M

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Contribution of Flow Cytometry in the Diagnosis of Cutaneous Lymphoid Lesions  Hong Wu, Mitchell Smith, Michael M. Millenson, Nicos Nicolaou, Vivianna M. Van Deerlin, Kathkali Addya, Stuart Lessin, Tahseen Al- saleem  Journal of Investigative Dermatology  Volume 121, Issue 6, Pages 1522-1530 (December 2003) DOI: 10.1046/j.1523-1747.2003.12631.x Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Multiple erythematous nodules and papules were present on the upper extremities (case 6). Journal of Investigative Dermatology 2003 121, 1522-1530DOI: (10.1046/j.1523-1747.2003.12631.x) Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Cutaneous follicular large cell lymphoma. In case 3, a punch biopsy showed a dense dermal lymphocytic infiltrate with nodular arrangement (a). The infiltrate was composed of large atypical cells (b) that were CD20 positive on an IHC stain (c). Flow cytometry revealed an abnormal population of B cells with dim λ light chain expression (d, R2 indicated by red). When the large cells were gated for analysis (e), there was a predominance of λ-expressing cells (f, R2 indicted by red). Scale bars: (a) 200 μm; (b), (c) 10 μm. Journal of Investigative Dermatology 2003 121, 1522-1530DOI: (10.1046/j.1523-1747.2003.12631.x) Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Cutaneous marginal zone lymphoma. A punch biopsy (case 8) showed patches of lymphocytic infiltrate (a). The cells were medium sized and monotonous (b). Most of the cells were CD20 positive on an IHC stain (c). Flow cytometry analysis gated on the small and medium sized lymphocytes (d) showed a striking predominance of κ positive CD19+ B cells (e, f). Scale bars: (a) 200 μm; (b), (c) 10 μm. Journal of Investigative Dermatology 2003 121, 1522-1530DOI: (10.1046/j.1523-1747.2003.12631.x) Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Cutaneous lymphoma with crush artifact on histologic sections. A punch biopsy (case 4) showed a lymphocytic infiltrate in the dermis, with crush artifacts in many areas (a). In some areas, there appeared to be an increased number of large, atypical cells (b). A CD20 immunostain showed increased numbers of CD20+ B cells (c). Flow cytometry analysis on the gated large lymphoid cells (d) revealed a predominance of κ-expressing CD19+ B cells over λ-expressing B cells (e, f). Scale bars: (a) 100 μm; (b), (c) 10 μm. Journal of Investigative Dermatology 2003 121, 1522-1530DOI: (10.1046/j.1523-1747.2003.12631.x) Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Tumor stage MF with large cell transformation. A punch biopsy (case 19) showed a dermal tumor (a). In addition to the numerous small to medium sized atypical lymphocytes, there were increased numbers of large atypical cells and increased mitoses (b). Flow cytometry revealed an abnormal T cell population that was CD3+(dim), CD4+, and lacked CD7 expression (c, d, indicated in red). Scale bars: (a) 200 μm; (b) 10 μm. Journal of Investigative Dermatology 2003 121, 1522-1530DOI: (10.1046/j.1523-1747.2003.12631.x) Copyright © 2003 The Society for Investigative Dermatology, Inc Terms and Conditions