A rare case of primary cutaneous diffuse large B-cell lymphoma, leg type in a patient with chronic lymphedema of the leg

A rare complication of chronic lymphedema is development of cutaneous malignant tumors particularly cutaneous lymphomas. We report a case of primary cutaneous diffuse large B-cell lymphoma, leg type, associated with chronic lymphedema of the lower limbs. A literature review identified 12 additional cases of primary cutaneous lymphomas associated with chronic lymphedema. Chronic lymphatic stasis may cause a local dysfunction of the immune system that predisposes to the induction of neoplasia, cutaneous lymphomas in particular.

Primary cutaneous amyloidosis: A clinico-pathological study with emphasis on polarized microscopy.

Background: Primary localized cutaneous amyloidosis (PCA) is a relatively rare condition characterized by amyloid deposition in dermis without systemic involvement. Although, histopathological examination of the lesion reveals amorphous eosinophilic deposits in papillary dermis examination of congo red stained slides under polarized light will give definitive diagnosis Aims: To study the clinicopathological features of cutaneous amyloidosis emphasizing the utility of polarized light in diagnosis. Materials and Methods : A clinicopathological study of primary cutaneous amyloidosis over a period of 8 years was undertaken. All the cases, clinically diagnosed and histopathologically proven as cutaneous amyloidosis were stained with congo red and studied under polarized light. Results and Conclusions: Of the 45 cases of clinically suspected amyloidosis, 32 cases were proven histopathologically as primary cutaneous amyloidosis and confirmed by congo red stain under polarized light which showed apple green birefringence. Among the two types of PCA, lichen amyloidosis was the most common variant accounting to 65.63% with pure cases of macular amyloidosis accounting for only 15.63%. Biphasic amyloidosis was seen in 18.75%. Knee was the commonest site of involvement with pruritis being the most common symptom. Histopathologically, the most common findings were hyperkeratosis, irregular acanthosis and expansion of dermal papillae by amyloid deposits showing apple green birefringence under polarized microscope with congo red staining. Although, H and E stain gives a clue for the diagnosis of amyloid nevertheless congo red staining under polarized light forms a very sensitive and definitive method for confirmation.

Erythematous nodules of the hand: A rare site of metastatic breast carcinoma.

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.

Subcutaneous Panniculitic-Like T-Cell Lymphoma: A red alert! The role of a vigilant histopathologist.

Subcutaneous panniculitic-like T-cell lymphoma constitutes a distinctive clinicopathologic entity derived from cytotoxic T lymphocytes. A 25-year-old female presented with fever and skin lesions over the upper limb, lower limb and trunk since 2 years. On examination, there were multiple subcutaneous, tender, erythematous, poorly circumscribed indurated plaques and nodules on the upper limbs and lower limbs. Histopathological examination revealed subcutaneous fat displaying a predominantly lobular infiltration of atypical lymphoid cells. Characteristically, there was rimming of individual fat cells by the surrounding neoplastic lymphocytes. Immunohistochemical evaluation of the neoplastic lymphocytes showed CD3 and CD5 immunoreactivity and CD30 and CD20 negativity. A diagnosis of subcutaneous panniculitic T-cell lymphoma was made. SPTCL is a rare cytotoxic lymphoma that can be misdiagnosed as benign panniculitis due to similarities in clinical and histological features between the two entities and thus cause a diagnostic hindrance.

Sporotrichosis in Mysore: a case report to emphasize the role of histopathology.

Lymphocutaneous sporotrichosis is unusual in southern India. The diagnosis was made by histopathological examination which is purported to have poor sensitivity. The culture of the specimen confirmed the diagnosis. The pre-eminent role of a careful study of serial sections is emphasized.