PMC3350019_01
(a) Skin with dense lymphoid infiltrate, consisting of medium to large lymphocytes with dense chromatin, irregular nuclear contours, and occasional prominent nucleoli, shave biopsy (H&E, Original Magnification x400). (b) Patient at presentation with a single necrotic lesion on the big toe. (c) Immunostaining negative for NPM-ALK gene product (original magnification x400). (d) Multiple satellite lesions that appeared 3 weeks after initial presentation.
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Originally, he presented with a single 2 x 2 centimeter necrotic lesion in the right 1st toe (Figure 1(b)). CD3 and CD30 and negative for CD 20, CD56, and for p80 tyrosine kinase (Figure 1(c)). CT of the chest, abdomen, and pelvis was negative for extra-cutaneous involvement. Additional lesions appeared on the lateral aspect of the foot (Figure 1(d)), ankle, and thigh 3 weeks after patient first came to our clinic. After careful evaluation of the literature, we decided to treat the patient with six cycles of CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone).