Red-brown nodules on the lower extremities of a 74-year old female

Presenter: Leela Athalye, Michael Kassardjian
Dermatology Program: Western University/Pacific Hospital of Long Beach
Program Director: Dr. David Horowitz
Submitted on: Jan 2, 2013

CHIEF COMPLAINT:  Painful and swollen lesions of left lower extremity

CLINICAL HISTORY:

Signs and symptoms:  5-month history of painful lesions on the left lower leg. Prior to appearance of lesions, patient had noted numbness and burning of left lower extremity. Patient denied systemic symptoms. No relevant prior medical history or family history.

Previous Treatment:  None

Other information:

PHYSICAL EXAM:

Four ill-defined, coalescing 1-cm violacious plaques with surrounding erythema on the left anterior tibia

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Low power demonstrates diffuse inflammatory infiltrate of the dermis and subcutis with a Grenz zone. On higher power, large round immunoblasts are appreciated. Staining for Bcl-2 and MUM-1 is diffusely positive

 

DIFFERENTIAL DIAGNOSIS:

1.   Cutaneous T-cell lymphoma
2.   B-cell Pseudolymphoma
3.   T-cell Pseudolymphoma
4.   Follicle Center B-cell lymphoma
5.   Marginal Zone B-cell Lymphoma


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