Diagnostic and management challenges in primary cutaneous anaplastic large cell lymphoma with necrosis, inflammation, and surgical intervention: A case report

Figure 1 Preoperative condition. Preoperative view of an 89-year-old female patient with diabetes and hypertension. A and B: A 4 cm × 4 cm tumor and a 3 cm × 3 cm skin defect on the arm and a 9 cm × 5 cm tumor and a 1.5 cm × 1.5 cm skin defect in the abdomen.

Figure 2 Contrast-enhanced computed tomography images. A and B: A 2.9 cm × 1.8 cm × 4.9 cm tumor in the left arm with a deep subcutaneous layer enhancement and invasion pattern; C and D: A 4.7 cm × 4 cm × 0.7 cm soft tissue defect in the central abdomen below the umbilical button; No signs of cancer metastasis.

Figure 3 Morphologic and vascular features of tumor necrosis. A and B: Microscopically, in the background of multifocal geographic tumor necrosis, highly pleomorphic lymphoid cell infiltration is noted; C: Vascular invasion with surrounding necrosis is identified and marked with white arrow; D: In situ hybridization for Epstein–Barr virus-encoded RNA (EBER) showing reactivity (A: H&E, × 5; B: H&E, × 20; C: H&E, × 10; D: EBER in situ hybridization, × 20).

Figure 4 Immunophenotyping of tumor cells. The tumor cells are reactive for CD4 and CD56 but negative for CD8 and CD20. A: CD20, × 20; B: CD8, × 20; C: CD56, × 20; D: CD20, × 20.