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Reniform ulcers: Unique presentation of multifocal primary cutaneous anaplastic large cell lymphoma
*For correspondence: swastika.p@gmail.com
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 45 yr old female† with no significant medical history presented to the department of Dermatology, King George's Medical University, Lucknow, India, in June 2018, with multiple elevated lesions on the upper limb, trunk and lower limb for the last six months. Cutaneous examination revealed multiple, non-tender hard nodules measuring 1-5 cm and numerous well-defined reniform-to-elliptical nodules, with ulceration at centre varying in size of 15-20 × 5-10 cm present predominantly over the groin and right thigh. Ulcers had sloping edges, floor covered with yellowish brown slough and were fixed to the underlying structures (Figure A and B).There were no significant systemic findings. Biopsy from the ulcer edge and nodule showed diffuse infiltration of the dermis and sub-cutis by atypical large lymphoid cells; CD30 and CD4 immunopositive; leucocyte common antigen (LCA) weak positive; anaplastic lymphoma kinase 1 (ALK1), CD3, CD8, CD56 and CD20 negative and Ki67 proliferation index of 60-70 per cent (Figure C-E). Haematological parameters and radiological examinations were non-contributory. A diagnosis of multifocal primary cutaneous anaplastic large cell lymphoma (PCALCL) was made. Multifocal PCALCL is rare, seen in only 20 per cent of the patients of PCALCL, and likely to have extracutaneous involvement later. Injection methotrexate 15 mg weekly was advised, but the patient did not comply and expired after three months.
- (A) Multiple nodules (red arrows) and reniform ulcers (black arrows) on the right leg, thigh and groin. (B) Close-up view of reniform ulcer (arrow) on the right thigh. (C) Diffuse infiltrate of large-sized lymphoid cells in the dermis having round-to-irregular nucleus with granular chromatin, conspicuous nucleoli and moderate cytoplasm (arrows). Mitoses are frequent (H and E stain, ×200). (D) Tumour cells with typical membrane and Golgi zone immunopositivity (arrow) (IHC CD30, Diaminobenzidine Chromogen, ×400). (E) Tumour cells showing high proliferation index (arrow) (IHC Ki67, Diaminobenzidine Chromogen, ×100).
Acknowledgment:
Authors acknowledge Drs Sucheta Pathania and Kiranpreet Malhotra, Departments of Dermatology, King George's Medical University and Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, respectively, for their substantial contribution.
Conflicts of Interest: None.
