A healthy 80-year-old Chinese man presented with a 2-month history of a 6 x 6 cm erythematous plaque on the right forearm that had gradually increased in size. He saw a dermatologist 2 months ago, had a biopsy and was told it was an insect bite reaction. However, he did not recall any insect bite reaction. I repeated his skin biopsy as it was not responding to treatment..
Clinical and Histopatological Photos
Pathology: Section shows epidermis with mild spongiosis. The dermis shows dense, superficial and deep perivascular infiltration of lymphocytes and plasma cells. There is no significant increase of eosinophils. The infiltrate extends along the sweat ducts, hair follicles and sebaceous glands. The superficial subcutaneous fat shows lymphocytes and plasma cells infiltration. The deeper dermis shows marked increased in eosinophils. There is no granulomatous lesion or atypical bizzare lymphocytes seen. The deeper dermis and subcutaneous fat are normal. No granuloma or nerve hypertrophy seen.
INTERPRETATION
Reactive lymphoid proliferative disorder or lymphocytoma cutis.
No granuloma seen to suggest leprosy or cutaneous TB.
Follow up with IHC stains.
CD3: CD20 showed mixed populations of the lymphoid cells.
CD10: positive weak for genimal centre
BCL2: negative for geminal centre
BCL6: positive for geminal centre
CD30 negative
EBER: negative
cMYC negative
EMA negative
Ki67 no marked increase in mitosis
Discussion: The pathologists concluded reactive lymphoid proliferative disorder or lymphocytoma cutis.
Questions: Is this benign or does it have a malignant potential? Does he warrant further work up or perhaps follow up closely to watch his progression? Thanks for your input!
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