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Figure 1: Multiple confluent erythematous nodules and plaques
in the lower legs and lower back at presentation (upper panel).
Resolution of skin lesions with residual pigmentation following 2 cycles
of SMILE chemotherapy (lower panel).
Figure 2: Skin biopsy histopathology and immunochemistry a)
Diffuse dermal and subcutaneous infiltrate of lymphoma cells (H and E,
x20). b) Higher magnification demonstrating medium to large in size
pleomorphic lymphoma cells with hyperchromatic nuclei and irregular
nuclear outlines (H and E x400) c) Strong cytoplasmic CD3 (epsilon)
expression of lymphoma cells in periadnexal and perivascular
distribution. d) Epstein-Barr Virus Encoded RNA (EBER) expression of
lymphoma cells, including in perivascular (red arrow) and perineurial
(blue arrow) distribution. e) Cytoplasmic expression of the cytotoxic
protein Granzyme B by the lymphoma cell (H and E x200). f) Moderate to
strong CD56 expression by the lymphoma cells (H and E x400).