PMC9271285_01
Image before treatment. A 12 cmx12 cm cluster of erythematous infiltrated consolidated papulonodules presented on the extensor surface of the patient's proximal lower right extremity.
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A complete skin examination demonstrated that he was otherwise healthy, but a cluster of 12 cm12 cm, erythematous infiltrated consolidated papulonodules were discovered on the extensor surface of his proximal right lower extremity (Figure 1).
(A) Granz zone can be seen between the epidermis and dermis (arrow indication). A condensed disseminated infiltration of lymphocytes in the entire dermis (hematoxylin-eosin, original magnification: 40x). (B) Atypical cells and abnormal mitosis of large cells can be seen (hematoxylin-eosin, original magnification: 400x).
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Excisional skin biopsy demonstrated a condensed disseminated infiltration of lymphocytes in the entire dermis with a granz zone between the epidermis and dermis (Figure 2A). Clustered atypical cells and abundant neoplastic immunoblasts and centroblasts can be seen in the dermis (Figure 2B).
Immunochemistry stain showed CD20 (A), CD79a (B), Bcl-2 (C), Bcl-6 (D) positivity, MUM-1 negativity (E).
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CD20 (Figure 3A) and CD79a (Figure 3B). CD3, Bcl-2 (Figure 3C), Bcl-6 (Figure 3D), CD5, CD10, CD30, MYC, and Ki-67 also showed positive expression. MUM-1 was negative (Figure 3E).
Six months after the six chemotherapy sessions, the skin lesions disappeared completely.
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Nearly 100% remission of the lesion was achieved after the sixth treatment session (Figure 4).