PMC5312184_01
Lymphomatoid papulosis. A) Multiple erythematous papules, some with
small erosions covered by scales and crusts and scarring lesions
distributed symmetrically. B) Details of the lesions in three
distinct evolutionary stages: the marking indicates a fully
developed lesion (ideal for biopsy); under it, there is an ulcerated
papule in involution; above, there is a completely regressed
lesion
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Affected areas included the trunk, buttocks, thighs, legs, arms, and forearms (Figure 1).
Lymphomatoid papulosis type C. A) Dermis showing a V-shaped cell
infiltrate associated with blurring of the dermal-epidermal
junction, rectification of epidermal cones, and hyperkeratosis
(Hematoxylin & eosin x40). B) Dense cellular infiltrate on the
dermis, consisting of lymphocytes with large pleomorphic vesicular
nuclei and conspicuous cytoplasm. Some binucleate lymphocytes
resembling Reed-Sternberg cells are present (Hematoxylin & eosin
x400)
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The biopsy of an infiltrated non-ulcerated papule revealed hyperkeratosis, rectification of the epidermis, and dense V-shaped infiltrate in the dermis, consisted of round cells with conspicuous cytoplasm and large pleomorphic vesicular nuclei, sometimes bevelled, displaying coarse nucleoli (Figure 2).
PMC5312184_02
Primary cutaneous anaplastic large cell lymphoma. Nodular and tumor
lesions with ulcerated surface present on the right foot, leg, and
arm
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One month before, the patient presented with hardnodules on his right arm, leg and tight, following an upward path culminating in bulging in the ipsilateral inguinal region (Figure 3).
Primary cutaneous anaplastic large cell lymphoma. Dense diffuse
infiltrate in the dermis, consisting of lymphocytes with large
pleomorphic vesicular nuclei and conspicuous cytoplasm. Mitotic
figures are easily visualized (Hematoxylin & eosin x400). Inset:
diffuse positivity of neoplastic lymphocytes in immunohistochemical
reaction with anti-CD30 primary antibody (Hematoxylin & eosin
x400)
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Mitoses were easily observed (Figure 4).
PMC5312184_03
Systemic anaplastic large T-cell lymphoma. Ulcerated nodule on the
left scapular region
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Dermatologic evaluation was requested due to a recent appearance of an ulcerated papule in the left scapular region (Figure 5).
Systemic anaplastic large T-cell lymphoma. Dense diffuse infiltrate
in the dermis, consisting of lymphocytes with large pleomorphic
vesicular nuclei and conspicuous cytoplasm (Hematoxylin & eosin
x400). Inset: diffuse positivity of neoplastic lymphocytes in
immunohistochemical reaction with anti-ALK primary antibody
(Hematoxylin & eosin x400)
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A biopsy revealed ulcerated skin fragment with diffuse infiltration, consisting of lymphoid cells containing large vesicular nuclei, with abundant pale cytoplasm (Figure 6).
PMC5312184_04
Large-cell transformation of mycosis fungoides. Plaque in polycyclic
configuration with eroded surface. Ulceration covered by a blackened
crust in the central portion. Note that the skin around the plaque
reveals discreet erythema and fine scales that extended throughout
the body
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An 89-year-old female patient reported the appearance of nodular lesions on her left arm and in the posterior thoracic region, and a large eroded plaque with circinated edges in the right scapular region (Figure 7).
Large-cell transformation of mycosis fungoides. A) Dermis showing
band-like infiltration in the papillary portion and around the skin
appendages in depth (Hematoxylin & eosin x20). B) Dermis showing
lymphocytes with large pleomorphic vesicular nuclei and abundant
cytoplasm, interspersed with small lymphocytes and eosinophils
(Hematoxylin & eosin x400)
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Skin biopsy revealed an infiltrate with a striated distribution in the papillary dermis and perivascular at depth, consisted of lymphoid cells of broad cytoplasm and large pleomorphic vesicular nuclei with one or more nucleoli (Figure 8).