Red-brown nodules on the lower extremities of a 74-year old female

Presenter: Leela Athalye DO, Michael Kassardjian DO

Dermatology Program: Western University/Pacific Hospital of Long Beach

Program Director: Dr. David Horowitz

Submitted on: January 2, 2013

CHIEF COMPLAINT: Painful and swollen lesions of left lower extremity

CLINICAL HISTORY: 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. No previous treatments.

PHYSICAL EXAM:
Four ill-defined, coalescing 1-cm violaceous plaques with surrounding erythema on the left anterior tibia

LABORATORY TESTS: N/A

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