PMC9772607_01
Well-circumscribed 5 cm x 3 cm ulceration with satellite lesions located on the right posterior labium majus.
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Dermatologic history was notable for a suspected exaggerated response to arthropod bites (Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/wwxdg9x8z6.1) with associated lichen simplex chronicus. Physical exam revealed well-demarcated 5 cm x 3 cm ulceration with satellite lesions on the right posterior labium majus (Fig 1).
A, Hematoxylin and eosin stain of the right posterior labium majus revealed a dense atypical B-cell lymphocytic infiltrate consistent with her previously diagnosed chronic lymphocytic leukemia. The epidermis is mildly acanthotic. At the dermis there is a dense infiltrate of small round lymphocytes with extensive crush artifact (2x). B, Immunocytochemical stains show that the infiltrate is a mixture of both T and B cells (CD20, CD79a, and CD3) with a predominant B-cell population (10x). C, Immunocytochemical stain showing that the B-cell co-express CD5 (strong) and CD23 (weak and focal), consistent with chronic lymphocytic leukemia (10x).
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Biopsy revealed a mildly acanthotic epidermis and a mixed dermal lymphocytic infiltrate with B-cell predominance (Fig 2, A). B-cells and CD3+ T-cells (Fig 2, B). B-cells also had strong CD5 co-expression and weak focal CD23 co-expression (Fig 2, C).
Resolving, well-circumscribed, and ulcerative right vulvar lesion with visible pink granulation tissue after receiving chemotherapy and palliative radiation.
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The patient achieved resolution of her vulvar ulceration (Fig 3) 1-2 months later and remains stable on venetoclax.
Draining ulcer with pink granulation tissue on the anterior abdomen at the site of a previous surgical incision.
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She had a focal draining ulcer with granulation tissue (Fig 4).