PMC5977007_01
Skin lesions. (a) multiple scar-like bluish-red lesions on both arms. (b) indurated, erythematous scar-like lesion on the left cheek. (c, d) Skin biopsy showing massive lymphohistiocytic infiltration focally with formation of granulomas (H&E, 100x and 400x, resp.). There was a dominance of CD8+ T-cells and also an increased proportion of CD4/CD8 double-negative T-cells.
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fig1
There had been numerous biopsies over the years showing an uncharacteristic massive lymphoid infiltration dominated by CD8+ lymphocytes and histiocytes and with some granulomas (Figure 1).
Affection of facial muscles and internal organs. (a) MR of the neck showing a large ulcerating tumor on the left side with infiltration into nearby muscles. (b) CT of the abdomen showing massive thickening of the ventricular wall due to lymphoma with infiltration also into the spleen and left adrenal gland. (c, d) Skin biopsy from the neck lesion showing sheets of lymphoid cells throughout dermis, with large pale gray nuclei with prominent nucleoli (H&E, 100x and 400x, resp.). On immunohistochemistry, the cells were positive for CD20, Pax5, Bcl-2, MUM1, and EBERISH and negative for CD3, CD4, CD5, CD8, CD30, CD10, Bcl-6, and cyclin D1. Ki-67 showed a proliferative fraction of 70-80% of tumor cells. The lesion was classified as diffuse large B-cell lymphoma.
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fig2
One year before presentation at Oslo University Hospital, the patient was found to have a diffuse large cell B-cell lymphoma (non-GC-B type, EBV+) in a tumor of the neck and at the same time another different B-cell lymphoma (unclassifiable, with features intermediate between diffuse large-B cell lymphoma (DLBCL) and classical Hodgkin lymphoma) preauricularly (Figure 2).