case_images: PMC9900238_01
case_images: (A) Lesion on the upper left chest showing a poorly demarcated erythematous plaque with infiltrating small nodules over the upper medial border. The plaque is 5.0 cm in maximum diameter x 2.0 cm. (B) Lesion on the upper left back showing a well demarcated erythematous nodule. The nodule is 2.5 cm in maximum diameter x 2 cm.
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case_images: The plaque had a maximum diameter of 5.0 cm x 2.0 cm, with no ulceration and no tenderness (Figure 1A). The lesion on the left upper back was found to be a well demarcated erythematous nodule with maximum diameter of 2.5 cm x 2.0 cm, and it was not tender on palpation (Figure 1B).
case_images: (A) (200x) The superficial and deep dermis show patchy dense lymphoid infiltrate. (B) (400x) The dermal infiltrate consists of large lymphoid cells (arrows) with round to oval abnormal nuclei surrounded by small mature lymphocytes in excess.
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case_images: The dermal infiltrate consisted of large lymphoid cells with round to oval abnormal nuclei surrounded by small mature lymphocytes in excess of 70% (Figure 2).
case_images: (A) (200x) Immunohistochemical stains show strong positivity of the large cells with CD20. (B) (200x) The reactive small lymphocytic populations are positive for CD3 immunohistochemical stain.
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case_images: Immunohistochemical stains of the large cells showed strong positivity with CD20 (Figure 3A) and CD79a, fair positivity with CD43 and paired box protein 5. The small lymphocytic populations were positive for CD3 (Figure 3B), CD5, and CD7.
case_images: Sites of the lesions after completing 12 sessions of electron beam radiotherapy showing post-inflammatory hyperpigmented patches and scars of previous skin punch biopsies. (A) Lesion on the upper left chest. (B) Lesion on the upper left back.
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case_images: The patient, after being treated with electron beam radiotherapy at a dose of 24 Gy delivered in 12 daily fractions (2 Gy/fraction) and square field size of 25x25 cm2 on his left upper chest, and 20x20 cm2 on his left upper back, showed complete resolution and no recurrence within a 24-month follow-up time frame (Figure 4).  
case_images: Fluorescence in situ hybridization (FISH) of (A) IGH break-apart (two fusion signals). (B) BCL6 break-apart (two fusion signals). (C) t(14;18)(q32;q21) (two green and two Orange signals). The tumor cells reveal no evidence of rearrangement (break-apart) in the IGH and BCL6 genes or in t(14;18)(q32;q21).
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case_images: For the t(14;18)(q32;q21) probe, a result with one fusion plus one green and one orange signal is considered positive for t(14;18)(q32;q21) while a result with two green plus two orange signals is considered normal (Figure 5).