Case report
A 50-year-old man visited the outpatient dermatology clinic of Faghihi
Hospital (Shiraz, Iran) in December 2021 with the chief complaint of a
rapidly growing lesion on his temple area. The patient had noticed a
small round lesion that appeared abruptly, with rapid growth during the
last two months. There was no sign or symptom of pain, tenderness,
pruritis, bleeding, discharge, or hypoesthesia. Skin examination
revealed a solitary, round, firm, 1×1.2 cm erythematous nodule with a
sharp, well-defined border on the patient’s temporal area (Fig. 1).
Neither lymphadenopathy nor any other systemic symptoms were found in
the general examination. The patient had no specific history of surgery,
rheumatoid arthritis, malignancy, or any other disease or medication
usage. There was also no family history of similar cutaneous lesions or
other diseases.
An excisional biopsy with a safety margin of 0.5 mm was taken under
local anesthesia. The specimen was fixed in formalin and studied by an
expert dermatopathologist. The histopathologic study revealed thinning
of the epidermis with a dense partly diffuse partly nodular infiltration
of small to medium-sized atypical lymphocytes and a few large atypical
lymphocytes, plasma cells, and histiocytes scattered in the entire
dermis, extending to the subcutaneous fat. The infiltrate was separated
from the dermis by the grenz zone (Fig. 2).
Immunohistochemical studies revealed that 90% of the lymphoid cells
were CD4+, a few CD8+, and the majority of those cells were positive for
CD3, CD5, and CD7, but negative for CD30, CD20, BCL6, CD10, PAX 5, and
MUM1. Ki67 was 10% (Table 1) (Fig. 3). The final diagnosis was primary
cutaneous CD4+ small to medium T- cell lymphoproliferative disorder.
Further laboratory tests were normal, including a complete blood count
and lactate dehydrogenase assay. The biopsy specimens were reviewed by a
dermatopathologist, who confirmed the mentioned findings. No significant
signs of recurrence were observed over two months of follow-up.