A 72-year-old female patient was referred to us for a 2-month history of an asymptomatic erythematous nodule on her left chest, which had been suspected to be a malignant lymphoma due to the results of an aspiration biopsy. Physical examination revealed a well-circumscribed and dome-shaped nodule measuring 2 cm in diameter on her left chest. Histopathologic features included a diffuse dermal infiltrate with extension into the subcutis, composed predominantly of small to medium-sized atypical lymphocytes. Epidermotropism was rarely seen. Immunohistochemically, atypical lymphocytes were CD3 positive, CD4 positive, and CD30 negative, and were associated with reactive CD8 positive T cells and CD20 positive B cells. The TCR gene was clonally rearranged. Soluble interleukin (IL)-2 receptor was within the normal range, and human T- lymphotrophic virus (HTLV) -1 antibody was negative. We diagnosed the patient as having primary cutaneous CD4+ small/medium-sized pleomorphic T cell lymphoma. The lesion was completely excised and no relapse had occurred at 33 months follow-up.
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