Presenter: Leela Athalye DO, Michael Kassardjian DO
Dermatology Program: Western University/Pacific Hospital of Long Beach
Program Director: Dr. David Horowitz
Submitted on: Jan 2, 2013
CHIEF COMPLAINT: Painful and swollen lesions of left lower extremity
CLINICAL HISTORY:
Signs and symptoms: a 5-month history of painful lesions on the left lower leg. Prior to the appearance of lesions, the patient had noted numbness and burning of the left lower extremity. The patient denied systemic symptoms. No relevant prior medical history or family history.
Previous Treatment: None
Other information:
PHYSICAL EXAM:
Four ill-defined, coalescing 1-cm violaceous plaques with surrounding erythema on the left anterior tibia
LABORATORY TESTS:
DERMATOHISTOPATHOLOGY:
Low power demonstrates diffuse inflammatory infiltrate of the dermis and subcutis with a Grenz zone. On higher power, large round immunoblasts are appreciated. Staining for Bcl-2 and MUM-1 is diffusely positive
1. Cutaneous T-cell lymphomaDIFFERENTIAL DIAGNOSIS:
2. B-cell Pseudolymphoma
3. T-cell Pseudolymphoma
4. Follicle Center B-cell lymphoma
5. Marginal Zone B-cell Lymphoma