Subcutaneous panniculitis‐like T‐cell lymphoma presenting as venous stasis ulceration

Abstract

Case Report A 68-year-old woman presented with extensive lower-extremity ulceration that had been ongoing and progressivefor 5 months. This process had been attributed to venousinsufficiency with secondary bacterial cellulitis. A biopsyspecimen obtained early in the course of her illness demon-strated epidermal and dermal necrosis with associated dermalhemorrhage and abscess. However, the specimen did notinclude a substantial portion of the panniculus.The patient’s condition modestly improved after a courseof antibiotics and localized wound care. New areas of ulcer-ation and necrosis developed (Fig. 1), however, and thepatient experienced recurrent fevers (up to 40 ° C), increasingfatigue, weight loss of 3.2 kg, and a progressive decrease inher hemoglobin level (11.1 g/dl down to 9.8 g/dl) over thepast 2–3 months.A repeat skin biopsy specimen demonstrated a denselobular lymphoid infiltrate composed of medium to largeatypical lymphoid cells which rimmed adipocytes and wasaccompanied by nuclear fragmentation (karyorrhexis) andcytophagocytosis (Fig. 2).Immunoperoxidase stains were performed on formalin-fixed, paraffin-embedded tissue. The atypical lymphoid cellswere immunoreactive against CD2, CD4, CD45RO, CD43,TIA-1, and granzyme B (Fig. 3) but were nonimmunoreactiveagainst CD3, CD5, CD7, CD8, CD30, and α / β T-cell recep-tor (TCR).