A 77 year old male presented with red non-tender plaques on the scalp for one week

    Dr. George Tjionas is a 4th resident in Dept of Pathology, Miller School of Medicine University of Miamia and pesenting this case.




    A 77 year old male presented with sudden pruritic rash mainly in the top of the head that he had for 1 week’s duration. He has never had a similar eruption in the past. Shortness of breath, fatigue, abdominal pain, and anorexia were associated. The scalp lesion showed multiple pink to red slightly non-blanchable, non-tender plaques with mild scale. The patient has a history of recently relapsed stage 3 mantle cell lymphoma (MCL) diagnosed 8 years ago. Under the clinical impression of lymphoma cutis, a skin punch biopsy was performed. 


    Histological sections showed pandermic infiltrates of lymphoma sparing adnexal structures and extending focally into the subcutaneous adipose tissue. Subtle epidermal involvement was noted but the most of epidermis was spared. The lymphoma was composed of uniform medium to large-sized tumor cells with blastic vesicular nuclei and inconspicuous nucleoli. Frequent mitosis (20 / 10HPF) including atypical forms was appreciated and a high cell proliferation rate was confirmed by Ki67 (100%). As the patient has a known relapsed MCL,the selected immunophenotying was performed. The tumor cells were positive for cyclin D1 and CD20 and negative for CD23. Immunophenotype also confirmed a mantle cell lymphoma. In the context of clinical history of relapsed systemic MCL, and histological and immunophenotypical findings, a diagnosis of blastic mantle cell lymphoma involving the skin was rendered.