Abstract: 45 yo man with one year history of a tumor on the nasal tip.
HPI: The patient is a 45 yr old man with a growth on the tip of nose for a year. It started as an asymptomatic papule last year and was shaved off by a GP. He remained well till 3 months ago when it started to recur. He had seen few doctors and the last doctor, a plastic surgeon decided to refer to a dermatologist. He lives in Teluk Intan about 100 km south from Ipoh. He is an excavator driver, does mainly outdoor work and has no family history of skin cancer.
O/E: Examination showed a firm non tender nodule 1.5 x 1.5 cm on the tip of the nose with a crateriform centre. Regional nodes were not enlarged.
Clinical Photos:
Pathology: An incisional biopsy was done on the tumor. Biopsy done showed diffuse and nodular infiltration of lymphocytes in the reticular dermis and deeper layers, separated by variable amount of fibrocollagenous tissue. Admixed with the lymphocytes are few eosinophils and plasma cells. There is no epidermotropism. The epidermis is unremarkable. Mitotic figures are discernable.
Immunohistochemical studies were performed on the tissues. The lymphoid population showed a polyclonal population of both T cell and B cell markers. A diffuse positivity of pan T markers CD 3 along with CD5 were noted. Patchy distribution of the B cell markers throughout is noticed for CD20, CD79a, PAX5 and MUM 1. Ki67 shows a proliferation index of 30-40% in the entire population.
Diagnosis (Tentative): Lymphocytoma Cutis
Questions: Is the immunohistochemistry supportive of lymphocytoma cutis (cutaneous B-cell pseudolymphoma) or cutaneous lymphoma? Will excision of the tumor help? If surgery is not contemplated, what would be recommmended treatment?
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