CASE REPORT
A 24 year-old man presented to our dermatology department for an
asymptomatic deep rippling lesions on the frontal level of the scalp
evolving for 2 months. He had no past medical history. Dermatology
examination revealed multiple large nodules on deeply infiltrated
erythematous-violaceous skin limited to the frontal area of the scalp
resulting in folds that mimick the surface of the cerebral cortex
(Figure1A). Dermoscopy revealed dotted vessels, fine short linear
vessels and scales over a salmon-pink background (Figure 1B). Physical
examination revealed no locoregional adenopathies. Histopathologic
examination revealed a dense infiltration in the dermis, made by medium
sized immature lymphoid cells, with a high mitotic index (Figure 2A).
There was no epidermotropism. Immunohistochemical stains were positive
for terminal deoxynucleotidyl transferase (TdT), CD3, CD4 and CD8 and
negative for CD20 (Figure 2B, 2C). The diagnosis of secondary CVG
associated with T-LBL was made. The patient’s general condition worsened
within a few days and he started complaining of debilitating dyspnoea
and productive cough. The patient underwent computed tomography of the
chest, abdomen and pelvis, which revealed a large mediastinal mass
measuring 15.5cm*10cm*22cm associated with pleural and pericardial
effusions as well as multiple bilateral renal masses. A transthoracic
needle biopsy was performed, confirming the diagnosis of pulmonary
involvement with T-cell lymphoblastic lymphoma. The patient received
chemotherapy.