Tracadie, New Brunswick
The patient is a 60 yo man who presented with a six months history of two asymptomatic erythematous nodules on the torso. He has been in his usual state of health otherwise. No history of fever, chills or night sweats.
O/E: There are two erythematous nodules located on the right abdomen and the left upper back. They measure 3 - 4 cm in diameter. No other cutaneous findings.
Clinical Photos:
New Lesion 10.25,16 R, Upper Back)
Pathology:
A superficial and deep nodular and interstitial infiltrate of CD20 positive B-lymphocytes admixed with CD3 positive T-lymphocytes with slight preponderance of B-cells. There is a scattering of CD30 positive lymphocyres. There appears to be a Grenz zone. Gene rearrangement studies are not indicative of either a clonal T or B cell lymphoproliferative disorder.
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| CD 3 |
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| CD 20 |
Lab: CBC, Chemistries, Serum protein electrophoresis all normal. IgG, IgM and IgG were all normal.
Diagnosis: The differential is between an atypical lymphoid infiltrate and a cutaneous lymphoma. We are leaning towards the former. Note: The last clinical photo was taken ~ 1 month after the others and shows progression. We plan to excise this recurring tumor for help with diagnosis.
Questions:
Should we treat? and if so how?
Should we follow with active surveillance?Would any of you make a a more specific diagnosis?
Is any further testing indicated at this time?
Follow-up 2.3.16
The patient's lesions come and go. All tests for systemic disease are negative. New lesion (see photo) on left chest 2 cm in diameter seen today. Will try to treat with clobetasol ointment.
10.16.16. Old lesions have disappeared and new lesions develop. Bo evidence of systemic disease.
Reference:
1. Atypical lymphoid proliferations: the pathologist's viewpoint. Hussein MR. Expert Rev Hematol. 2013 Apr;6(2):139-53. doi: 10.1586/ehm.13.4.
Abstract: Lymphoid proliferations are traditionally thought
to be either benign conditions (reactive hyperplasia and lymphadenitis) or
malignant lymphomas. However, not all lymphoid lesions at present can be
precisely placed into one of these categories.
2. Cutaneous B-cell lymphomas: 2015 update on diagnosis,
risk-stratification, and management. Wilcox RA. Am J
Hematol. 2015 Jan;90(1):73-6. Free Full Text Online.
