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A 49-year-old Chinese woman presented with enlarged left cervical lymph nodes for 2 months in September 2010. She had no visible lesions on her skin. Computed tomography (CT) revealed enlarged bilateral cervical lymph nodes and hepatosplenomegaly. Lymph node biopsy revealed that the normal lymph node architecture was destroyed by smallto medium-sized lymphoid cells with clear cytoplasm and mildly irregular nuclei (Fig. 1A). Plasma cells, eosinophils and scattered large immunoblast-like lymphoid cells were observed. Those smallto medium-sized lymphoid cells were positive for CD3, CD4, CD10, PD-1, and CXCL-13, but negative for CD20 and CD30. The scattered large immunoblast-like cells were positive for CD20 and weakly positive for CD30. The proliferation of follicular dendritic cells was highlighted by CD21 and CD23 staining. No EBER-positive cells were observed on an in situ hybridization assay. A diagnosis of AITL was made according to World Health Organization (WHO) classification criteria (1). The patient received 6 cycles of chemotherapy with CHOP regimen (cyclophosphamide, doxyrubin, vincristine, prednisone), which led to complete remission. She was followed-up for 21 months without treatment, with no further symptoms. In June 2012, the patient developed multiple plaques and nodules, with ulcers on her trunk and extremities (Fig. 1B). The lesions had nodal and perivascular proliferation of smallto medium-sized lymphocytes in the dermal and upper subcutis, with scattered large-sized atypical lymphoid cells. The smallto medium-sized lymphocytes were positive for CD3 and CD4, but negative for CD10, CD20, PD-1 and CXCL-13. The large atypical cells were positive for CD20 and weakly positive for CD30, and negative for CD3, CD4 and CD10. The patient was diagnosed with cutaneous lymphoid atypical proliferation. After diagnosis, the patient was treated with prednisone, 30 mg/ day for 3 weeks, and most of the lesions disappeared. However, one nodule on the chest persisted and enlarged after 2 months. A second biopsy of the chest nodule revealed diffuse proliferation of medium-to-large-sized atypical lymphoid cells in the dermal and subcutis, mixed with numbers of HRS-L large cells (Fig. 1C, D). The medium-to-large-sized cells expressed CD20 (Fig. 1E), CD79a, Bcl-2, Bcl-6 and MUM-1. The HRS-L cells expressed CD20 in varying degrees (Fig. 1F). Both of the populations of cells were negative for CD3, CD5 and CD10. In addition, the HRS-L cells were positive for CD30 (Fig. 1G), but not for CD15 and ALK. EBER were positive in 2 populations of cells. Based on these findings, a diagnosis of EBV+DLBCL was made. After reviewing all 3 biopsies, scattered atypical large-sized cells were found in the first skin biopsy. These cells weakly expressed Secondary Cutaneous Epstein-Barr Virus-associated Diffuse Large B-cell Lymphoma with Hodgkin/ Reed-Sternberg-like Cells in a Patient with Angioimmunoblastic T-cell Lymphoma

acta dermato-venereologica

Secondary Cutaneous Epstein–Barr Virus-associated Diffuse Large B-cell Lymphoma with Hodgkin/Reed-Sternberg-like Cells in a Patient with Angioimmunoblastic T-cell Lymphoma