Interactive Case Study - July 2020

Question 1:

An 86-year-old woman with a raised, reticular, pruritic rash on the left lateral shoulder of 2-3 months duration (Figure 1), estimated to have started after hospitalization for myocardial infarction.  Medical history includes left shoulder osteoarthritis, untreated torn left rotator cuff, and left-sided breast carcinoma treated with lumpectomy 30 years prior.  A punch biopsy of the area showed the following histopathology (Figure 2a-2c).  The cytokeratin AE1/AE3 stain is also shown (Figure 3a, 3b).  

Figure 1.


Figure 2a.


Figure 2b.


Figure 2c.


Figure 3a.


Figure 3b.

 
What is the most likely diagnosis?

A.	Intralymphatic histiocytosis

B.	Intralymphatic melanoma

C.	Intravascular lymphoma

D.	Intravascular papillary endothelial hyperplasia

E.	Recurrent breast carcinoma