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When present&#44; skin lesions appear as erythematous and&#47;or violaceous plaques&#44; papules or nodules&#44; either single or multiple&#44; with firm consistency&#44; pruritic or not&#46; It is noteworthy that BPDCN may already initially present with systemic involvement or develop&#44; from the primary cutaneous form&#44; into the secondary involvement of lymph nodes with systemic symptoms&#44; such as weight loss&#46; The mean survival comprises a few months &#40;12 to 14 months&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Therefore&#44; being an extremely rare disease with diverse clinical manifestations that remain scarcely described&#44; the diagnosis is a challenge from the clinical and histopathological point of view&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the above&#44; the aim of this article is to describe a case of BPDCN&#44; diagnosed in the early stages&#44; focusing on the histopathological findings through the proposition of a flowchart for histopathological diagnosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 38-year-old male patient showed erythematous-violaceous plaques and nodules associated with pruritus and distributed over the trunk&#44; upper limbs and forehead &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on dermatological clinical examination&#46; He denied weight loss&#44; fever&#44; or lymph node enlargement and did not report previous important diseases&#46; A biopsy was performed&#44; with the clinical hypotheses of drug reaction&#44; sarcoidosis&#44; urticarial vasculitis and mycosis fungoides&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathological examination disclosed a dense&#44; superficial and deep dermal infiltrate&#44; with diffuse and periadnexal involvement&#46; The infiltrate was characterized by cells with blast morphology&#44; displaying irregular nuclei&#44; granular chromatin&#44; one or more nucleoli&#44; and scarce agranular cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; There were frequent mitoses &#40;more than five mitoses per 1&#8239;mm<span class="elsevierStyleSup">2</span>&#41;&#44; including atypical forms&#46; Necrosis and angioinvasion were not observed&#46; The epidermis was preserved and separated from the neoplasm by a Grenz zone&#46; Immunohistochemistry showed positivity for CD45&#44; CD4&#44; CD43&#44; CD56&#44; TDT&#44; CD123&#44; a high cell proliferation index &#40;Ki-67 estimated at 50&#37;&#41; and negativity for the other tested markers &#40;CD3&#44; CD20&#44; CD30&#44; CD34&#44; CD138&#44; and myeloperoxidase&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46; Complementary exams performed included computed tomography &#40;CT&#41; of the skull&#44; thorax and abdomen&#59; cerebrospinal fluid &#40;CSF&#41; sampling&#59; myelogram&#59; bone marrow karyotype&#59; immunophenotyping of the bone marrow and bone marrow biopsy&#46; They did not reveal extracutaneous involvement by the neoplasm&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The HyperCVAD scheme &#40;hyperfractionated cyclophosphamide&#44; vincristine&#44; doxorubicin&#44; and dexamethasone alternated with high doses of methotrexate and cytarabine&#41; was the treatment used in this case&#44; with good results&#44; and the patient is still being evaluated for a possible allogeneic bone marrow transplant&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">BPDCN was first described in 1994 as an NK cell lymphoma&#44; due to the positive expression of CD56&#44; and it was only in 2016 that it was classified as separate type of lymphoma by the World Health Organization &#40;WHO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The poor prognosis requires early suspicion and diagnosis so that treatment can be as effective as possible&#46; For surgical pathologists&#44; BPDCN must be considered in case of dermal infiltration by neoplastic cells with blast morphology&#46; Immunohistochemistry is essential for the final diagnosis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the presence of a case with dermal infiltration by a poorly differentiated neoplasm&#44; CD45 positivity confirms the hematolymphoid origin&#46; Negativity for CD3&#44; CD20&#44; CD138 and myeloperoxidase markers exclude T lymphocyte&#44; B lymphocyte&#44; plasma cell and myeloid differentiation&#44; respectively&#46; CD56 positivity confirms the cytotoxic profile&#46; It should be noted that BPDCN also expresses T cell markers such as CD4 and CD43&#44; as well as markers of immature cell neoplasms such as TDT&#59; however&#44; there is no CD34 expression&#44; a frequently positive marker in blast cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the possible good initial response to chemotherapy&#44; the cases invariably show recurrence&#44; with fulminant leukemia being one of the main causes of death&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The main differential diagnoses from the histopathological point of view are cutaneous infiltration by myeloproliferative neoplasms or myelodysplastic syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Considering the other CD56-positive cutaneous neoplasms&#44; the diagnosis based on clinical aspects&#44; microscopic morphology and immunohistochemistry&#44; allows ruling out the other differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Clinically&#44; it is possible to rule out the possibility of lymphomatoid papulosis&#46; Moreover&#44; CD30 negativity helps to rule out cutaneous CD30-positive neoplasms&#46; From the morphological point of view&#44; the absence of necrosis&#44; angiocentrism and destruction of the vascular wall rule out the possibility of an extranasal T&#47;NK cell lymphoma&#46; CD56-positive acute myeloid leukemia &#40;AML&#41; skin infiltration may share immunophenotypic markers with BPDCN&#59; however&#44; AML will rarely be CD123-positive and more commonly expresses myeloperoxidase&#44; a negative marker in BPDCN&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As for treatment modalities&#44; the impact of using anti-CD123 targeted therapy &#40;tagraxofusp&#41; for BPDCN remains debatable&#59; however&#44; studies show a good response to this drug either as the first line of treatment or for disease recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It must be considered that the low incidence of BPDCN influences the small number of available therapeutic possibilities&#44; as well as hinders a deeper understanding of this neoplasm from a molecular point of view&#46; It is noteworthy that&#44; contrary to the false idea that dermatological diseases have a good prognosis&#44; BPDCN must be recognized by dermatologists and pathologists to accelerate the diagnosis and allow early treatment&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Gabriel Taylor Castolde&#58; Literature review and writing of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Alexandre Lizardo Lourenco Pontes&#58; Dermatologist responsible for patient care&#59; performance of the biopsy and critical review of the final version of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Gabriel Macedo Cortopassi&#58; Hematologist responsible for the treatment&#44; help writing the manuscript and critical review of the final version of the manuscript&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Jos&#233; C&#226;ndido Caldeira Xavier-J&#250;nior&#58; Design of the manuscript and the flowchart&#59; writing of the manuscript&#59; study supervision and review of the final version of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Violaceous plaque on the lower dorsal region&#46; &#40;B&#41; Infiltrated erythematous nodules and plaques on the forehead&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Panoramic view&#58; note the intact epidermis and the Grenz zone &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46; &#40;B&#41; Note the involvement of the deep dermis &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46; &#40;C&#41; In detail&#44; area of periadnexal involvement around the sweat glands &#40;Hematoxylin &#38; eosin&#44; &#215;200&#41;&#46; &#40;D&#41; Detail of cells with immature morphology&#44; scarce cytoplasm and granular chromatin &#40;Hematoxylin &#38; eosin&#44; &#215;400&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibody&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Policlonal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4B12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ber-H2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QBEnd 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DF-T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2B11&#43;PD7&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PG-M1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6H6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">MI15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TDT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">EP266&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Myeloperoxidase&nbsp;\t\t\t\t\t\t\n
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Letter – Dermatopathology
Blastic plasmacytoid dendritic cell neoplasm: diagnostic difficulty and proposed flowchart for histopathological diagnosis
Gabriel Taylor Castoldea, Alexandre Lizardo Lourenço Pontesb, Gabriel Macedo Cortopassib, José Cândido Caldeira Xavier-Júniora,c,d,
Corresponding author
josecandidojr@yahoo.com.br

Corresponding author.
a Faculty of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, SP, Brazil
b Private Practice, Araçatuba, SP, Brazil
c Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
d Instituto de Patologia de Araçatuba, Araçatuba, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Blastic plasmacytoid dendritic cell neoplasm &#40;BPDCN&#41; is a rare lymphoma&#47;leukemia with an incidence of 0&#46;44 cases per 100&#44;000 people&#44; with a mean age range of 53 to 68 years and a male-to-female ratio of 3&#58;1&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The etiology of BPDCN is unknown&#46; The presentation and clinical course of the disease are widely heterogeneous&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> There are no documented genetic&#44; environmental&#44; or hereditary factors that predispose to its development&#44; but approximately 10&#37; to 20&#37; of the patients have a previous history of hematological malignancies&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">BPDCN is characterized by aggressive behavior with rapid spread&#46; When present&#44; skin lesions appear as erythematous and&#47;or violaceous plaques&#44; papules or nodules&#44; either single or multiple&#44; with firm consistency&#44; pruritic or not&#46; It is noteworthy that BPDCN may already initially present with systemic involvement or develop&#44; from the primary cutaneous form&#44; into the secondary involvement of lymph nodes with systemic symptoms&#44; such as weight loss&#46; The mean survival comprises a few months &#40;12 to 14 months&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Therefore&#44; being an extremely rare disease with diverse clinical manifestations that remain scarcely described&#44; the diagnosis is a challenge from the clinical and histopathological point of view&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the above&#44; the aim of this article is to describe a case of BPDCN&#44; diagnosed in the early stages&#44; focusing on the histopathological findings through the proposition of a flowchart for histopathological diagnosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 38-year-old male patient showed erythematous-violaceous plaques and nodules associated with pruritus and distributed over the trunk&#44; upper limbs and forehead &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; on dermatological clinical examination&#46; He denied weight loss&#44; fever&#44; or lymph node enlargement and did not report previous important diseases&#46; A biopsy was performed&#44; with the clinical hypotheses of drug reaction&#44; sarcoidosis&#44; urticarial vasculitis and mycosis fungoides&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathological examination disclosed a dense&#44; superficial and deep dermal infiltrate&#44; with diffuse and periadnexal involvement&#46; The infiltrate was characterized by cells with blast morphology&#44; displaying irregular nuclei&#44; granular chromatin&#44; one or more nucleoli&#44; and scarce agranular cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; There were frequent mitoses &#40;more than five mitoses per 1&#8239;mm<span class="elsevierStyleSup">2</span>&#41;&#44; including atypical forms&#46; Necrosis and angioinvasion were not observed&#46; The epidermis was preserved and separated from the neoplasm by a Grenz zone&#46; Immunohistochemistry showed positivity for CD45&#44; CD4&#44; CD43&#44; CD56&#44; TDT&#44; CD123&#44; a high cell proliferation index &#40;Ki-67 estimated at 50&#37;&#41; and negativity for the other tested markers &#40;CD3&#44; CD20&#44; CD30&#44; CD34&#44; CD138&#44; and myeloperoxidase&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; <a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46; Complementary exams performed included computed tomography &#40;CT&#41; of the skull&#44; thorax and abdomen&#59; cerebrospinal fluid &#40;CSF&#41; sampling&#59; myelogram&#59; bone marrow karyotype&#59; immunophenotyping of the bone marrow and bone marrow biopsy&#46; They did not reveal extracutaneous involvement by the neoplasm&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The HyperCVAD scheme &#40;hyperfractionated cyclophosphamide&#44; vincristine&#44; doxorubicin&#44; and dexamethasone alternated with high doses of methotrexate and cytarabine&#41; was the treatment used in this case&#44; with good results&#44; and the patient is still being evaluated for a possible allogeneic bone marrow transplant&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">BPDCN was first described in 1994 as an NK cell lymphoma&#44; due to the positive expression of CD56&#44; and it was only in 2016 that it was classified as separate type of lymphoma by the World Health Organization &#40;WHO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The poor prognosis requires early suspicion and diagnosis so that treatment can be as effective as possible&#46; For surgical pathologists&#44; BPDCN must be considered in case of dermal infiltration by neoplastic cells with blast morphology&#46; Immunohistochemistry is essential for the final diagnosis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the presence of a case with dermal infiltration by a poorly differentiated neoplasm&#44; CD45 positivity confirms the hematolymphoid origin&#46; Negativity for CD3&#44; CD20&#44; CD138 and myeloperoxidase markers exclude T lymphocyte&#44; B lymphocyte&#44; plasma cell and myeloid differentiation&#44; respectively&#46; CD56 positivity confirms the cytotoxic profile&#46; It should be noted that BPDCN also expresses T cell markers such as CD4 and CD43&#44; as well as markers of immature cell neoplasms such as TDT&#59; however&#44; there is no CD34 expression&#44; a frequently positive marker in blast cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the possible good initial response to chemotherapy&#44; the cases invariably show recurrence&#44; with fulminant leukemia being one of the main causes of death&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The main differential diagnoses from the histopathological point of view are cutaneous infiltration by myeloproliferative neoplasms or myelodysplastic syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Considering the other CD56-positive cutaneous neoplasms&#44; the diagnosis based on clinical aspects&#44; microscopic morphology and immunohistochemistry&#44; allows ruling out the other differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Clinically&#44; it is possible to rule out the possibility of lymphomatoid papulosis&#46; Moreover&#44; CD30 negativity helps to rule out cutaneous CD30-positive neoplasms&#46; From the morphological point of view&#44; the absence of necrosis&#44; angiocentrism and destruction of the vascular wall rule out the possibility of an extranasal T&#47;NK cell lymphoma&#46; CD56-positive acute myeloid leukemia &#40;AML&#41; skin infiltration may share immunophenotypic markers with BPDCN&#59; however&#44; AML will rarely be CD123-positive and more commonly expresses myeloperoxidase&#44; a negative marker in BPDCN&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As for treatment modalities&#44; the impact of using anti-CD123 targeted therapy &#40;tagraxofusp&#41; for BPDCN remains debatable&#59; however&#44; studies show a good response to this drug either as the first line of treatment or for disease recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It must be considered that the low incidence of BPDCN influences the small number of available therapeutic possibilities&#44; as well as hinders a deeper understanding of this neoplasm from a molecular point of view&#46; It is noteworthy that&#44; contrary to the false idea that dermatological diseases have a good prognosis&#44; BPDCN must be recognized by dermatologists and pathologists to accelerate the diagnosis and allow early treatment&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Gabriel Taylor Castolde&#58; Literature review and writing of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Alexandre Lizardo Lourenco Pontes&#58; Dermatologist responsible for patient care&#59; 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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Ki-67 positivity illustrating the high rate of cell proliferation &#40;&#215;40 &#8211; panoramic view&#41;&#46; &#40;B&#41; Positive CD43 &#40;&#215;400&#41;&#46; &#40;C&#41; Positive TDT &#40;&#215;400&#41;&#46; &#40;D&#41; Positive CD56 &#40;&#215;400&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antibody&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Policlonal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4B12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ber-H2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QBEnd 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DF-T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2B11&#43;PD7&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PG-M1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6H6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MI15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EP266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Myeloperoxidase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Policlonal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ki-67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIB-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;High index&#58; estimated at 50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Results of the immunohistochemical panel applied in the present case&#46;</p>"
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                        "editores" => "D&#46;E&#46;Elder, D&#46;Massi, R&#46;A&#46;Scolyer, R&#46;Willemze"
                        "titulo" => "WHO Classification of Skin Tumours"
                        "edicion" => "4<span class="elsevierStyleSup">th</span> ed"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Venugopal"
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                            2 => "S&#46;M&#46; El Jamal"
                            3 => "A&#46;A&#46; Lane"
                            4 => "J&#46; Mascarenhas"
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                    0 => array:2 [
                      "doi" => "10.1016/j.clml.2019.06.002"
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                        "tituloSerie" => "Clin Lymphoma Myeloma Leuk&#46;"
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                        "volumen" => "19"
                        "paginaInicial" => "545"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31281107"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation&#58; an Italian multicenter study"
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                          "autores" => array:6 [
                            0 => "L&#46; Pagano"
                            1 => "C&#46;G&#46; Valentini"
                            2 => "A&#46; Pulsoni"
                            3 => "S&#46; Fisogni"
                            4 => "P&#46; Carluccio"
                            5 => "F&#46; Mannelli"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3324/haematol.2012.072645"
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                        "tituloSerie" => "Haematologica&#46;"
                        "fecha" => "2013"
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                        "paginaInicial" => "239"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outras doen&#231;as linfoproliferativas e mieloproliferativas"
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                          "etal" => false
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                            4 => "B&#46; Vergier"
                            5 => "M&#46; Beylot-Barry"
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                      "doi" => "10.1309/AJCPFMNYCVPDEND0"
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                        "tituloSerie" => "Am J Clin Pathol&#46;"
                        "fecha" => "2011"
                        "volumen" => "135"
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Article information
ISSN: 03650596
Original language: English
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