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Interactive Case Study - October 2026

75-year-old male with papules on chest, back, and arms
Sara Waqar, MD 
Jacqueline M. Junkins-Hopkins, MD 
Tammie C. Ferringer, MD 
 
 
A 75-year-old male presented with a one-month history of pruritic rash on his trunk and arms that did not respond to moisturizing agents. He reported worsening after showering. His past medical history was significant for chronic myelomonocytic leukemia, currently being monitored without treatment by oncology, with ongoing anemia (11g/dL), mild leukocytosis (13 × 10³/µL), and thrombocytopenia (28 × 10³/µL). Physical examination revealed erythematous macules and papules on his chest, back and arms. One of the papules was biopsied.
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MPDCN_Clinical photo
MPDCN_Clinical photo
MPDCN_Low-power view
MPDCN_Low-power view
MPDCN_High power-view (40X)
MPDCN_High power-view (40X)
MPDCN_High-power view (oil immersion lens 100X) first image
MPDCN_High-power view (oil immersion lens 100X) first image
MPDCN_High-power view (oil immersion lens 100X) second image
MPDCN_High-power view (oil immersion lens 100X) second image
MPDCP_CD123, CD4, CD5, CD3
MPDCP_CD123, CD4, CD5, CD3
MPDCP_CD56, TdT, Granzyme B, Ki-67
MPDCP_CD56, TdT, Granzyme B, Ki-67
The majority of the infiltrate showed positive immunohistochemical staining for CD123, CD24 and Granzyme-B. CD56, TdT and CD1a were all negative, and the Ki-67 proliferation rate was low. A small, admixed population of CD3-positive cells showed no loss of CD5 or CD7 expression. A spirochete stain was also performed, which was negative. Which of the following is the best diagnosis?
Blastic plasmacytoid dendritic cell neoplasm
Folliculotropic mycosis fungoides
Lichenoid drug eruption
Mature plasmacytoid dendritic cell proliferation associated with myeloid neoplasm
Tumid lupus erythematosus
Which of the following supports a mature plasmacytoid dendritic cell proliferation associated with an underlying myeloid neoplasm?
B-cell clonality test by PCR showing IGH rearrangement
CD123+, CD4+, CD56-
CD123+, CD4+, CD56+
High Ki-67 proliferation index (>70%)
Positive Epstein-Barr virus–encoded RNA in situ hybridization
  1. Jain A, Sweet K. Blastic Plasmacytoid Dendritic Cell Neoplasm. J Natl Compr Canc Netw. 2023;21(5):515-521. doi:10.6004/jnccn.2023.7026

    PMID: 37156483

  2. Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022;36(7):1703-1719. doi:10.1038/s41375-022-01613-1

    PMID: 35732831

  3. Fernandez-Flores A, Cassarino DS. Plasmacytoid dendritic cells in granulomatous variant of mycosis fungoides. J Cutan Pathol. 2019;46(5):335-342. doi:10.1111/cup.13438

    PMID: 30734340 

  4. Wu SJ, Hergott CB, Griffin GK, et al. The Clinicopathologic and Genomic Features of Mature Versus Blastic Plasmacytoid Dendritic Cell Neoplasms Arising From Chronic Myeloid Neoplasms. Am J Surg Pathol. Published online April 20, 2026. doi:10.1097/PAS.0000000000002556

    PMID: 42008303

  5. Dargent JL, Henne S, Pranger D, et al. Tumor-forming plasmacytoid dendritic cells associated with myeloid neoplasms. Report of a peculiar case with histopathologic features masquerading as lupus erythematosus. J Cutan Pathol. 2016;43(3):280-286. doi:10.1111/cup.12639

    PMID: 26449631

  6. Tomasini D, Mentzel T, Hantschke M, et al. Plasmacytoid dendritic cells: an overview of their presence and distribution in different inflammatory skin diseases, with special emphasis on Jessner's lymphocytic infiltrate of the skin and cutaneous lupus erythematosus. J Cutan Pathol. 2010;37(11):1132-1139. doi:10.1111/j.1600-0560.2010.01587.x

    PMID: 20659210 

  7. Machan S, Alonso-Dominguez JM, Sánchez García FJ, et al. Plasmacytoid Dendritic Cell Dermatosis Associated to Myeloproliferative/Myelodysplastic Neoplasms. Am J Surg Pathol. 2022;46(12):1623-1632. doi:10.1097/PAS.0000000000001960

    PMID: 37156483

  8. 8. Mahévas T, Osio A, Larcher L, et al. Cutaneous clonal mature plasmacytoid dendritic cell dermatosis in patients with myeloid neoplasms. Blood Adv. 2024;8(12):3293-3298. doi:10.1182/bloodadvances.2023012489

    PMID: 38621250

 

Acknowledgements

 

Author Profiles

Sara Waqar, MD

Geisinger Medical Center

I am a fourth-year pathology resident at Geisinger Medical Center in Danville, Pennsylvania, with a particular interest in dermatopathology. I have presented cases at ASDP and ISDP conferences, authored research articles, and remain actively engaged in dermatopathology education. I aspire to further develop my expertise in dermatopathology and to contribute meaningfully to the field through clinical practice, research, and teaching.

 

Jacqueline M. Junkins-Hopkins, MD

Geisinger Medical Center

Dr. Jacqueline M. Junkins-Hopkins is a distinguished dermatopathologist at Geisinger Medical Center, where she serves as a faculty member in dermatopathology and dermatology and contributes to the training of fellows in the dermatopathology fellowship program. She is widely recognized for her diagnostic expertise and long-standing contributions to clinical and academic dermatopathology. Her clinical and research interests focus on cutaneous T cell lymphoma, inflammatory dermatoses, and medical dermatopathology, with a particular emphasis on clinicopathologic correlation in challenging diagnostic scenarios. Through her scholarly contributions, she has advanced the understanding of both neoplastic and inflammatory skin disorders, publishing in leading journals and contributing to the evolving knowledge base in dermatopathology.

 

Tammie C. Ferringer, MD

Geisinger Medical Center

Dr. Tammie Ferringer is the Division Chief of Dermatologic, Oral and Soft Tissue Pathology and section head and fellowship director of dermatopathology at Geisinger Medical Center in Danville, Pennsylvania. She is a leader in advancing dermatopathology education and training, overseeing a highly regarded fellowship program and shaping the curriculum for dermatology residents with a strong emphasis on clinicopathologic correlation and diagnostic excellence. Her career reflects a sustained commitment to integrating clinical dermatology with histopathology, fostering a generation of dermatopathologists equipped with both diagnostic precision and clinical insight. Dr. Ferringer has held numerous national leadership roles, including service on the boards of the American Board of Dermatology, American Academy of Dermatology, and the ASDP, and participation in dozens of committees shaping education, certification, and practice standards. She has authored numerous peer reviewed articles and textbook chapters and contributed as a co editor of a dermatopathology textbook. Her academic work spans a broad range of topics in dermatopathology, including adnexal tumors, infectious diseases, and immunohistochemistry, reflecting her wide-ranging expertise and passion for advancing the field.

 

 

 

 

 

 

 

Question:

 

 

 

 
 

75-year-old male with papules on chest, back, and arms

Category

Tumors > Lymphomatous/Leukemic Infiltrates

Description

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