case_images: PMC7233898_01
case_images: Multiple erythematous nodules of aleukemic leukemia cutis on the patient's (A) chest, (B) left forearm, (C) left upper arm, and (D) left inner arm.
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case_images: A 40-year-old male patient presented to our clinic in January of 2017 with a 6-month history of dozens of painful nodules throughout his body (Figure 1), and progressive severe pain in his abdomen and joints.
case_images: (A) Medium power image highlighting the lack of significant atypia in the small lymphocytes. No mitoses or apoptoses are present. These lymphocytes could be mistaken as a normal reactive perivascular infiltrate. (B) Low power image showing a mild to moderate lymphocytic perivascular infiltrate with minimal cytologic atypia. This is a common pattern for reactive lymphocytic infiltrates.
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case_images: The lymphoid cells were small and showed minimal cytologic atypia (Figure 2).
case_images: Immunohistochemical stains highlighting the perivascular malignant cells: (a) CD43, (b) MPO, and (c) CD68.
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case_images: However, because of the cellularity of the infiltrate and the clinical history of persistent lesions, additional immunohistochemical stains were performed to further investigate the nature of the dermal cells (Figure 3).