A 50-year-old female patient presented with swelling of the left upper limb with some characteristic skin lesions. Patient gave history of undergoing MRM followed by chemotherapy and radiotherapy 7 years ago. A skin biopsy was taken. Which of the following markers would be most likely be positive in the above patient: –

**Core Concept**
The patient's history and presentation are suggestive of secondary lymphedema and possible chronic radiation damage following mastectomy (MRM) and adjuvant therapy. The skin biopsy is likely to show changes consistent with radiation dermatitis or lymphedema.

**Why the Correct Answer is Right**
The most likely marker to be positive in this patient is Podoplanin, which is a transmembrane glycoprotein expressed on the surface of lymphatic endothelial cells. In patients with lymphedema, especially secondary lymphedema following cancer treatment, Podoplanin expression is often upregulated, leading to increased lymphatic permeability and fluid accumulation. This marker is commonly used in the diagnosis of Kaposi's sarcoma and lymphangiosarcoma, but also has implications in the diagnosis of lymphedema and chronic radiation damage.

**Why Each Wrong Option is Incorrect**
* **Option A:** CD31 is a marker for endothelial cells, but it is not specific for lymphatic endothelial cells and is not the best marker for diagnosing lymphedema or chronic radiation damage.
* **Option B:** CD34 is a marker for hematopoietic progenitor cells and is not specific for lymphatic endothelial cells.
* **Option C:** Vimentin is a marker for mesenchymal cells, but it is not specific for lymphatic endothelial cells.

**Clinical Pearl / High-Yield Fact**
Podoplanin expression is often upregulated in conditions with increased lymphatic permeability, such as lymphedema, Kaposi's sarcoma, and lymphangiosarcoma. This marker can be useful in the diagnosis and management of these conditions.

**Correct Answer:** D.

✓ Correct Answer: A. CD31