PMC10034272_01
Clinical images (a) initial presentation: indurated violaceous sternal plaque
at the superior edge of the sternotomy scar (arrow), and second indurated
plaque at the left distal aspect of the central abdominal scar (arrow). (b)
Three months post-targeted radiotherapy and topical steroids application;
note the partial regression of the sternal plaque and complete regression of
the abdominal plaque resulting in an ivory color scar.
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On examination, two indurated violaceous plaques were noted at the superior edge of the sternotomy scar and on the left distal aspect of the central abdominal surgical scars (Figure 1(a)). At follow-up 3 months later, no new lesions appeared and the existing plaques were regressing with the continued use of the desoximetasone ointment (Figure 1(b)).
Microscopic and immunohistochemical findings. (a) Low power micrograph of the
skin excision showing the prominent lymphoid infiltrate. (b) Medium power of
the deep infiltrate composed of small to medium monotonous lymphoid cells.
(c) High power of the intraepidermal Pautrier microabscess. (d-g)
Immunostains for CD3, CD4, CD8, and CD7, respectively: note the predominance
of CD4+ over CD8+ cells and loss of CD7 that stains only residual
non-neoplastic T-cells.
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Microscopic examination revealed a prominent multinodular and diffuse superficial, mid and deep dermal infiltrate of atypical T lymphocytes with epidermotropism and rare Pautrier microabscesses (Figure 2(a)-(c)). Immunohistochemistry showed the cells were predominantly CD2-, CD3-, and CD4-positive with loss of CD5 and CD7; 10%-20% of cells were CD30-positive and the Ki-67 proliferation rate was estimated at 10%, consistent with a primary CTCL with features of mycosis fungoides (MF) (Figure 2(d)-(g)).