Diffuse CD30-Positive Cutaneous Infiltrate in a Clinically Suspected Hidradenitis Suppurativa Lesion: Histopathologic and Diagnostic Challenges.
R Gervasi, G L Piazzetta, G Soluri et al.
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Case in brief
A 38-year-old male presented with a lesion in the left axilla, initially diagnosed as hidradenitis suppurativa (HS) and unresponsive to antibiotics. Surgical excision revealed a dense infiltrate of atypical lymphoid cells, consistent with anaplastic large cell lymphoma (ALCL). Despite initial concerns of primary cutaneous ALCL, further imaging indicated regional lymph node involvement. The patient underwent chemotherapy and autologous stem cell transplantation, achieving complete metabolic remission.
What made this case unusual
The case illustrates the diagnostic challenges of distinguishing between CD30-positive lymphoid infiltrates and benign inflammatory conditions like HS, particularly when lesions exhibit atypical features.
Diagnostic / clinical pearl
Clinicians should consider early biopsy and immunophenotypic analysis in atypical or treatment-resistant skin lesions to differentiate malignant from reactive lymphoid infiltrates.
Why it matters
This case underscores the importance of recognizing histopathologic features that can lead to misdiagnosis, highlighting the need for careful clinicopathologic correlation in dermatological practice.