Table of Content

Current Issue

Spring 2019, Vol. 27 No. 1

Hong Kong J. Dermatol. Venereol. (2019) 27, 43-44


Dermato-venereological Quiz

Dermato-venereological Quiz

SM Wong 黃思敏 and P Tsui 徐波

A 78-year-old woman who had previously enjoyed good past health, presented with low-grade fever and a non-tender erythematous plaque with necrotic centre, measuring 4.5 x 6 cm in diameter (Figure 1). This lesion rapidly increased in size over a few weeks. She also reported recent weight loss of more than 10 lbs. in the past three months.

On examination, she was found to have lymphadenopathy over cervical, axillary and groin areas, wwith the largest one measuring 2 cm in diameter in the cervical region. There was no palpable hepatosplenomegaly.

Blood examination showed pancytopaenia, with Hb 9.6g/dL (NR 11.5-14.8 g/dL), platelet count 55 x109/L (NR:154-371 x109/L), absolute neutrophil count was 0.4 x109/L (NR 2.01-7.41 x109/L).

Figure 1 Non-tender erythematous plaque with a necrotic centre on the chin.

Figure 2 Diffuse cellular infiltrates in skin with ulcer (H&E x 100).

Figure 3 Mixed population of large atypical cells and medium cells (H&E x 400).

Figure 4 T-cell marker: CD3 positive in atypical medium sized cells (x 400).

Figure 5 B-cell marker: Pax5 positive in large atypical cells (x 400).

Questions

  1. What are the clinical differential diagnoses?
  2. What will be the initial management and investigations?