A 78-year-old man, with no morbid history, presented with a two-month history of swelling in the forehead, with no associated symptoms.
Physical examination revealed a firm, elastic tumor, not adhered to deep planes, measuring 1.7 x 0.6 cm, with some erythematous papules slightly translucent on the surface and multiple telangiectasias.
The lesion was removed and sent to pathology with clinical diagnosis of basal cell carcinoma on epidermal cyst.
At the time of clinical follow-up, one week later, the patient presented another smaller tumor in the supra-right region, similar to the first.
Pathological examination of the frontal tumor showed a neoplasm compatible with HS.
Imaging studies (computed tomography of the head and neck) showed multiple nodular lesions in subcutaneous cellular tissue in both temporal regions, as well as submandibular and jugular-digastric adenopathies.
Nodules were also observed in both parotid glands.
Laboratory studies included blood count showing the following values: hemoglobin, 16.0 gr/dF (reference values (VR), 13.5-17.5); hematocrit, 45.8% (VR, 41-53-11mm); platelets, 140 xVR).
The leukocyte count was: neutrophils, 53%; eosinophils, 4%; monocytes, 18% and lymphocytes, 25%.
Other laboratory tests (biochemical profile and liver tests) were within normal ranges.
The patient was treated in another institution and unfortunately was lost for clinical follow-up.
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CHANGES
Microscopically, a frontal tumor showed diffuse cellular proliferation, in superficial and deep dermis, non-epidermotropic and with Grenz zone.
It is formed by medium to large cells with epithelioid appearance and variable pleomorphism, which includes multinucleated forms.
A prominent lymphocytic component, numerous mitoses and apoptotic bodies were also observed.
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Immunohistochemically, cytokeratins showed positive reaction for CD43, CD45, CD4 (partial), CD30 (diffuse), CD68, CD163, myelooperoxidase, CD20 and protein S.
Myelogram and bone marrow biopsy showed bone marrow hypoplasia with mild dysplastic changes.
Clonality study using polymerase chain reaction technique showed polyclonal rearrangement of T and B lymphocytes.
