PMC3873170_01
Gross description of left-shoulder lesions.
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Physical exam revealed macular, lightly pigmented lesions on the chest and left shoulder (Fig. 1).
Circulating neoplastic cell (Wright-Giemsa; original magnification x100).
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Routine labs included a complete blood count (CBC), which showed a white blood cell count of 3,200, with the differential reported as 44% lymphocytes and 9% atypical lymphocytes (Fig. 2), hemoglobin of 11.2, with a mean corpuscular volume of 106.9, and a platelet count of 80,000.
Neoplastic cells in bone marrow aspirate (Wright-Giemsa; original magnification x50).
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The aspirate showed numerous mononuclear cells with fine nuclear chromatin, variable prominence of nucleoli, and finely vacuolated cytoplasm, comprising 75% of the cells (Fig. 3).
Dermal infiltrate of neoplastic cells (hematoxylin and eosin; original magnification x50).
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A punch biopsy of the left upper chest lesion showed a monomorphic population of mononuclear cells in the dermis that was infiltrative of adnexal structures (Fig. 4).