Case Study: November 2015

History

A 70 year old female has bilateral blepharochalasis (Fig 1), worse on the right. She undergoes a routine blepharoplasty and the tissue is submitted for ophthalmic pathologsy evaluation as the it is felt not to be entirely normal.

Questions:

1. Describe Fig 2.

2. What does Fig 3 show?

3. This is a CD3 stain-what does it show?

4. Which histopathology lab test should be performed next?

5. What is the most favoured diagnosis?

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1. A folliculocentric infiltrate of ? inflammatory cells.

2. The cells are mostly irregular-shaped lymphocytes.

3. This shows an intensely folliculotropic T-cell infiltrate.

4. Testing for T-cell monoclonality.

5. The T-cells were clonal in this case. In the context of the other features, the diagnosis is eyelid folliculotropic mycosis fungoides. The patient developed red patches on her trunk that confirmed the same diagnosis.

References

Stenson S, Ramsay DL. Ocular findings in mycosis fungoides Arch Ophthalmol. 1981 Feb;99(2):272-7.

Gül U, Soylu S, Aslan E et al. Uncommon presentation of mycosis fungoides: eyelid margin involvement. J Dermatol. 2008 Sep;35(9):581-4.