Asymptomatic Pink Nodules on a 28-Year-Old Patient: Case rep
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A 28-year-old Asian American male with no past medical history presented with enlarging pink nodules and skin texture changes on the left triceps for approximately one year in duration. Patient denied any previous trauma or injury to the site. Review of symptoms and history were reviewed extensively with patient. Physical exam revealed no lymphadenopathy. A punch biopsy showed a dense lymphoid infiltrate consisting of small to medium-sized lymphocytes containing abundant plasma cells. A panel of immunohistochemistry stains demonstrated many CD3+ T-cells and vast collections of CD20+ B-cells with a much
greater number of T-cells. The plasma cells expressed Lambda light chain to a much greater degree than Kappa light chain.

Primary Cutaneous Marginal Zone Lymphoma (PCMZL) – is the most likely diagnosis if whole body PET scan were unremarkable. PCMZL accounts for approximately 40% of all cutaneous B-cell lymphomas and approximately 10% of all primary cutaneous lymphomas. It typically presents as pink to red nodules to plaques on the arms or trunk. It is a B-cell lymphoma with numerous T-cells.

Histological findings often show nodular and diffuse infiltrates of monocytoid B cells in the dermis and subcutaneous region. Lymphoid nodules contain central darker normal cells and paler peripheral neoplastic marginal zone cells. Numerous plasma cells are seen and some with Dutcher bodies. Intracytoplasmic monoclonal immunoglobulin kappa or lambda restriction often seen. This is the dermatopathology description of PCMZL.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30851-1/fulltext?rss=yes
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