case_images: PMC9271285_01
case_images: Image before treatment. A 12 cmx12 cm cluster of erythematous infiltrated consolidated papulonodules presented on the extensor surface of the patient's proximal lower right extremity.
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case_images: A complete skin examination demonstrated that he was otherwise healthy, but a cluster of 12 cm12 cm, erythematous infiltrated consolidated papulonodules were discovered on the extensor surface of his proximal right lower extremity (Figure 1).
case_images: (A) Granz zone can be seen between the epidermis and dermis (arrow indication). A condensed disseminated infiltration of lymphocytes in the entire dermis (hematoxylin-eosin, original magnification: 40x). (B) Atypical cells and abnormal mitosis of large cells can be seen (hematoxylin-eosin, original magnification: 400x).
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case_images: Excisional skin biopsy demonstrated a condensed disseminated infiltration of lymphocytes in the entire dermis with a granz zone between the epidermis and dermis (Figure 2A). Clustered atypical cells and abundant neoplastic immunoblasts and centroblasts can be seen in the dermis (Figure 2B).
case_images: Immunochemistry stain showed CD20 (A), CD79a (B), Bcl-2 (C), Bcl-6 (D) positivity, MUM-1 negativity (E).
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case_images: CD20 (Figure 3A) and CD79a (Figure 3B). CD3, Bcl-2 (Figure 3C), Bcl-6 (Figure 3D), CD5, CD10, CD30, MYC, and Ki-67 also showed positive expression. MUM-1 was negative (Figure 3E).
case_images: Six months after the six chemotherapy sessions, the skin lesions disappeared completely.
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case_images: Nearly 100% remission of the lesion was achieved after the sixth treatment session (Figure 4).