Abstract: 45 yo man with one year history of a tumor on the nasal tip.
HPI: The patient is a 45 yr old man with a growth on the tip of
nose for a year. It started as an asymptomatic papule last year
and was shaved off by a GP. He remained
well till 3 months ago when it started to recur.
He had seen few doctors and the last doctor, a plastic surgeon decided
to refer to a dermatologist. He lives in Teluk Intan about 100 km south from
Ipoh. He is an excavator driver, does mainly outdoor work and has no family
history of skin cancer.
O/E: Examination showed a firm non tender nodule 1.5 x 1.5
cm on the tip of the nose with a crateriform centre. Regional nodes were not
enlarged.
Clinical Photos:
Pathology: An incisional biopsy was done on the tumor. Biopsy done showed diffuse and nodular infiltration of lymphocytes in the reticular dermis and deeper layers, separated by variable amount of fibrocollagenous tissue. Admixed with the lymphocytes are few eosinophils and plasma cells. There is no epidermotropism. The epidermis is unremarkable. Mitotic figures are discernable.
Immunohistochemical studies were performed on the tissues.
The lymphoid population showed a polyclonal population of both T cell and B
cell markers. A diffuse positivity of pan T markers CD 3 along with CD5 were
noted. Patchy distribution of the B cell markers throughout is noticed for
CD20, CD79a, PAX5 and MUM 1. Ki67 shows a proliferation index of 30-40% in the
entire population.
Diagnosis (Tentative): Lymphocytoma Cutis
Questions:
Is the immunohistochemistry supportive of lymphocytoma cutis (cutaneous
B-cell pseudolymphoma) or cutaneous lymphoma? Will excision of the
tumor help? If surgery is not contemplated, what would be recommmended
treatment?
Dear DJE
ReplyDeleteMy D/D in addition would be Cutaneous Leishmaniasis. Kindly look for LD bodies. Also rK39 antigen could be done.
Best regards
Dr Manish Pahwa
New Delhi
From Mary Malonney (Chief of Dermatology, U of Massachusetts) "I think this is a vascular tumor as I see slits and vascular channels. That makes me think angiosarc or kaposi's, though the lesion itself is not very purple."
ReplyDeleteI would get a 2nd opinion on the path to be sure it's not angiosarc. In the old days when I was in private practice and had a superficial x-ray machine, I'd treat with that modality.
ReplyDeleteDo get a smear done for LD bodies (for leishmaniasis), though it does look like lymphocytoma cutis. I dont think it looks like a vascular tumor. My opinion would be to give symptomatic management and do a smear for LD bodies, which might turn out to be positive, u never know...
ReplyDelete