A Case of Primary Cutaneous Anaplastic Large Cell Lymphoma Presenting with Corkscrew Vessels on Dermoscopy
59 MDW San Antonio United States
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Corkscrew linear helical blood vessels on dermoscopy have been described as features of melanoma and cutaneous metastases1. The etiology of these vessels is unknown but the association with high-risk neoplasms is ominous and may be related to features unique to cancers with a high metastatic potential. We present a case of primary cutaneous anaplastic large cell lymphoma ALCL with prominent corkscrew blood vessels on dermoscopy. An 86-year-old man with a past medical history of basal cell carcinoma and prostate carcinoma presented to the dermatology clinic for a routine full body skin examination. An 8 by 5mm tan pink papule with minimal overlying scale was observed on his left posterolateral foot Fig 1. Dermoscopy demonstrated a tan pink background with central linear helical or corkscrew and coiled vessels and a small amount of overlying light-yellow scale Fig 2. Histology revealed a dermal lymphocytic proliferation that included a population of large atypical cells with prominent nucleoli and variable amounts of amphiphilic cytoplasm. This was in the context of a mixed inflammatory background with prominent neutrophils. The large atypical cells demonstrated multinucleate forms and occasional horseshoe shaped nuclei were present with conspicuous mitoses. These cells stained positively for CD30, TIA-1, CD4, and CD2 and were negative for ALK1, nuclear PAX-5, CD20, CD3, CD5, CD7, CD8, CD10, P40, AE1AE3, PSA, Mart1, and S100. The histologic diagnosis of a CD30 positive lymphoproliferative disorder was made with the differential diagnosis of lymphomatoid papulosis LyP, primary cutaneous anaplastic large cell lymphoma ALCL, or systemic ALCL with cutaneous involvement. The patient was referred to hematology and oncology where he underwent an extensive work up to include imaging and a bone marrow biopsy with no evidence of systemic disease.
- Medicine and Medical Research