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A 60\u2010year\u2010old male with a previous history of myelodysplastic syndrome presented with cutaneous nodules on chest and scalp. A punch biopsy specimen of a skin nodule showed a diffuse dermal infiltrate of atypical mononuclear cells. The neoplastic cells expressed CD4, CD56, CD43, and TdT but showed minimal reaction for TCL\u20101 and CD123, and were negative for CD34, CD117, and MPO, confounding the diagnosis. IRF8 performed in retrospect was strongly positive. A new punch biopsy specimen of a chest nodule showed the blastoid tumor cells were positive for TCL\u20101, CD4, and CD56, but dim CD123. Subsequent bone marrow involvement showed blastoid tumor cells with intense positivity for CD123, CD4, and CD56, which was supportive of the BPDCN diagnosis. BPDCN cases with weak or variable CD123 and TCL\u20101 expression represent a potential diagnostic pitfall. In a recent study, 15 cases of BPDCN showed uniformly strong staining for IRF8, while CD123 was dim or negative in 4 of these 15 cases. We suggest IRF8 may be a useful marker for BPDCN, especially in cases with weak or variable expression of CD123 and TCL1.<\/jats:p>","DOI":"10.1111\/cup.14439","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T08:20:13Z","timestamp":1682065213000},"page":"595-600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["<scp>IRF8<\/scp> may be a useful marker for blastic plasmacytoid dendritic cell neoplasm, especially with weak <scp>CD123<\/scp> expression"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-349X","authenticated-orcid":false,"given":"Haiming","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Pathology Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5762-3490","authenticated-orcid":false,"given":"Gauri","family":"Panse","sequence":"additional","affiliation":[{"name":"Department of Pathology Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetrios","family":"Braddock","sequence":"additional","affiliation":[{"name":"Department of Pathology Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhir","family":"Perincheri","sequence":"additional","affiliation":[{"name":"Department of Pathology Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina L.","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pathology Yale School of Medicine  New Haven Connecticut 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