Case Number : Case 2016 - 27 Feb 2018 Posted By: Iskander H. Chaudhry

Leukemia cutis in a patient with chronic myeloid leukemia ?

Cutaneous plasmacytosis vs Cutaneous Castleman's disease if one consider them separate entities. Need IHC plus close CPC. 

Grey infiltrate, granulomatous with lymphocytes and plasma cells. Think the following (Lues, Lymphoproliferative, Lyme, Leish, Leprosy, Lupus vulgaris). LPD looks a runner consider lymphomatoid granulomatosis, angioimmunoblastic T-cell and pseudolymphoma.  Systemc lymphomas (B- and T- ) can present with vaguely granulomatous infiltrate in the skin. Consider another histiocytosis like RDD. IHC & PCR will probably be required including Kappa & Lambda.

Thank you 

Dr Chaudhry has provided some more history:

Mid back biopsy excision of nodule. Patient dermal nodules 4/12 on trunk- mild itch. Stage 4 lymphoplasmacytoid T-Cell lymphoma 2009. Failed Chemo Etopocide in 2010 for 6/12 for symptom relief. Improved. Discharge in 2016 ?Recurrent lymphoma Patient thinks spleen enlarging in last few days.

Sincerely I was thinking of leprosy...

It would be difficult to comment further without a full immunohistochemical work up since the cells here look relatively bland.

Histiocytosis.

Dr Chaudhry's response:

Granulomatous pseudolymphoma - awaiting regional MDT review. Mixed T and B cells, Mature plasma cells and Granulomas. 

Cutaneous Rosai Dorfman ?