PMC5726683_01
Tumors, eyebrow and hairline alopecia
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On clinical examination, he had brown and edematous plaques on the frontal region, associated with alopecia of the eyebrows and hairline, in addition to a deforming tumor on the nose (Figure 1).
Plaques on the trunk and tumors on the upper limbs
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Slightly lichenified brown plaques were seen on the upper and lower limbs, predominantly on the trunk and ulcerated tumors on the upper limbs (Figure 2).
Psoriasiform epidermal hyperplasia, predominantly lymphocytic
folliculotropic infiltrate, loose epithelioid granulomas
(A: Hematoxylin & eosin, X100); lymphocytic
infiltrate involving the remaining external follicular sheaths
(B: Hematoxylin & eosin, X100)
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In July 2015 three new biopsies from different skin lesions were taken and the histopathology of the abdominal plaque revealed a dense atypical mononuclear infiltrate, involving the remaining follicular sheath and eccrine glands associated to psoriasiform hyperplasia of the epidermis and granulomatous reaction (Figure 3).
Cytokeratin (AE1/3) positivity in epithelial elements, highlighting the
destruction of the adnexal epithelium by tumor cells
(Immunohistochemistry, X40)
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T-cell cutaneous lymphoma, CD4 and CD30 positive (Figures 4 and 5). The patient was seen by the hematology team and chemotherapy with gemcitabine and interferon, associated to phototherapy were scheduled.
Predominance of CD4+ population (Immunohistochemistry, X40), mainly of
large cells; CD30+ (Immunohistochemistry x100) of large cells with more
atypia around vessels and appendages; CD8+ (Immunohistochemistry, X40)
in some lymphocytes; CD3+ e CD5+ (Immunohistochemistry, X100) in most
lymphoid cells; Ki-67+ (MIB1) in about 50% of nuclei
(Immunohistochemistry, X400)
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T-cell cutaneous lymphoma, CD4 and CD30 positive (Figures 4 and 5). The patient was seen by the hematology team and chemotherapy with gemcitabine and interferon, associated to phototherapy were scheduled.