Comment on Pseudopautrier's Abscess Dear Editor: We read with great interest article by Lee et al.1 entitled three dimensional conformal radiotherapy for hyperkeratotic plantar mycosis fungoides1. We agree with effectiveness of three-dimensional conformal radiotherapy for hyperkeratotic plantar mycosis fungoides (MF) and appreciate educational figures. However, in this case report, authors have described the presence of intraepidermal collections of mononuclear cells showing hyperchromatic atypical cells that were compatible with Pautrier's microabscesses (PA). We would like to suggest intraepidermal mononuclear collections described by authors are not consistent with PA, but with pseudopautrier abscesses (PPA), regarded as a marker of spongiotic processs. PA are one of pathologic hallmarks of MF. They represent punch-out spaces in epidermis filled with malignant T-lymphocytes (sometimes cerebriform). The aggregates of clonal T cells around Langerhans' cells explain dependence of T cells on interactions with these dendritic cells, particularly in early stages of disease2. PPA were first described as spongiotic stimulants of PA by Ackerman et al.3 in 1974. They consist of Langerhans cells, histiocytes, stellate keratinocytes and rare lymphocytes. In one study by Candiago et al.4, they were found in a variety of inflammatory disorders showing epidermal spongiosis, and were particularly frequent in spongiotic (43.4%), in lichenoid dermatitis (10%), and notably in MF (13.3%). Moreover, according to Kang et al.5, PPA were expressed in up to 25.5% of MF (24/94). They emphasize that differential diagnostic hallmarks between PPA and PA are morphology, cell types, and particularly additional immunohistochemical findings, as shown in Fig. 1, ,22. Fig. 1 (A) Histopathologic findings show pseudopautrier abscess (PPA, arrow) with focal spongiosis and spongiotic vesicles (H&E, ×100). (B~D) CD1a (B) as well as CD68 (D) is expressed on most cells within PPA (arrow), but negative for CD3 (C). ... Fig. 2 (A) Histopathologic findings display Pautrier's microabscess (PA, arrow) (H&E, ×100). (B~E) Most cells within PA (arrow) are positive for CD3, but negative for CD1a, CD68, and high molecular weight cytokeratin. Histologic findings considered as PA by Lee et al.1 favor more PPA, judging from adjacent prominent spongiosis, and predominance of nonlymphoid cells, showing presence of histiocyte, Langerhans cell, and stellate keratinocyte without atypical features. Additional immunohistochemical study will be also useful in differential diagnosis, using CD1a, CD3, CD4, CD68, and high molecular cytokeratin5. PPA are not an infrequent histologic finding in MF, particularly more common with MF palmaris et plantaris referring to hyperkeratotic MF5. Thus, it is not suitable to exclude diagnosis of MF unquestionably, when PPA are seen in biopsy specimen. In addition, when collections of intraepidermal mononuclear cells are observed in typical MF, clinician should be cautious before concluding they are PA, and a careful histological and immunohistochemical evaluation must be performed carefully to distinguish PPA from PA.