![]() ![]() After 5 weeks, the skin lesions had significantly receded and flattened ( Fig. He was prescribed narrow-band ultraviolet B phototherapy twice per week and adjuvant topical steroids as skin-directed therapy, combined with interferon-α subcutaneous injections as a systemic biologic modifier. Such staging studies revealed the patient to be T3, N0, M0, B0 (stage IIB) 3. Chest computed tomography (CT), neck CT, abdominal CT, and whole-body positron emission tomography–CT demonstrated no lymph node involvement or solid organ involvement. No definitive abnormal finding was seen on blood cell morphology or bone marrow chromosome tests, indicating an absence of significant peripheral blood involvement. Immunohistochemical phenotypic studies showing atypical lymphocytes. Because intraepidermal blisters and spongiosis were seen along with band-like dermal infiltrate of small to medium sized atypical lymphocytes that were predominately CD4 +, the patient was diagnosed with vesicular MF. Some of the large cells expressed CD30 + antigen while anaplastic lymphoma kinase (ALK) staining was negative ( Fig. Large cells that are at least four times larger than regular lymphocytes with round-to-oval nuclei were observed in the epidermis and dermis. Immunohistochemical analysis revealed that the lymphocyte infiltrate comprised predominantly CD4 + T cells, with a CD4:CD8 ratio greater than 10:1 ( Fig. Histopathological examination showed parakeratosis with acanthosis and rete ridge elongation as well as spongiotic intraepidermal blisters and dense dermal infiltration of small to medium sized atypical lymphoid cells ( Fig. Oozing red to brownish papules and plaques on trunk (A), legs (B, C), dorsum of foot (D), and biopsy site on the leg (E).įor further evaluation, a skin biopsy of an oozing plaque lesion on the calf was performed. One must consider vesicular MF as a differential for recalcitrant eczematous lesions. Vesicular MF is associated with poor prognosis, but our patient was able to show benign course of disease thanks to timely diagnosis. He was prescribed with narrow-band ultraviolet B twice per week and topical steroid, combined with interferon-α injection for 5 weeks, and his skin lesions significantly faded and were flattened. This histopathologic findings are consistent with vesicular mycosis fungoides (MF). Infiltration of large cells that were CD30 + were also noted. Immunohistochemical analysis revealed the lymphocyte infiltrate to be predominantly CD4 + T cells, with CD4/CD8 ratio to be greater than 10:1. Histopathological examination showed parakeratosis with acanthosis and rete ridge elongation as well as spongiotic intraepidermal blisters and dense dermal infiltration of small to medium sized atypical lymphoid cells. The lesions were resistant to topical and oral steroid prescribed at the other local clinics. A 44-year-old male presented with 7 months history of nonpruritic round oozing plaques on the extremities and red papules on the trunk. ![]()
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