Primary axillary anaplastic large cell lymphoma mimicking pyogenic granuloma clinically

According to World Health Organization (WHO) estimates, anaplastic large cell lymphoma (ALCL) is a neoplasm of large lymphoid cells with peripheral T-cell lymphoma (PTCL), representing approximately 2e3% of all lymphoid endoplasms. Clinically, ALCL presents two distinct subtypes, including widespread systemic disease and localized cutaneous disease. Systemic ALCL is an aggressive lymphoma that may exhibit secondary skin involvement except for extranodal sites. Cutaneous ALCL tends to have a solitary tumor or nodule that is often ulcerated and present on the extremities, face, or less frequently, the trunk [1]. Skin lesions present with localized, solitary papulonodular skin or subcutaneous nodules, and sometimes show ulcerated, infiltrated, necrotic, and easy-to-bleed lesions. Pyogenic granuloma (PG) is a common benign vascular tumor. The skin lesion is composed of smooth, dome-shaped, or pedunculated papules or nodules with a glistening surface [2]. Because of the similar clinical presentation of ALCL and PG, confusion and initially incorrect diagnoses might be a challenge to surgeons, especially because ALCL is a rare and uncommon disease. A 24-year-old man presented with a hard, painless subdermal nodule about 1 cm in size that developed over the right side axillary area about 2 years previously, and it had begun to enlarge progressively from the subdermal to epidermal layer. The well-defined, exophytic nodule with purulent discharge, measuring 3 cm 2 cm in size, was noted on the patient’s first visit to the outpatient department (Fig. 1A). Systemic disease involvement was suspected, and examination including positron emission tomography and bone scan were performed during hospitalization. The report disclosed the hot spots over the right