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Epstein-Barr virus-positive mucocutaneous ulcer, plasmablastic type, associated with nodal CD4+ angioimmunoblastic T-cell lymphoma and generalised pruritus: a self-limiting lymphoproliferative disorder resembling cutaneous plasmablastic lymphoma
  1. Yutaka Tsutsumi1,2,
  2. Seiya Kitano3,
  3. Soshi Yanagita4 and
  4. Mitsuhiro Tachibana5
  1. 1Division of Diagnostic Pathology, Tsutsumi Byori Shindanka Clinic, Inazawa, Aichi, Japan
  2. 2Department of Medical Technology, Yokkaichi Nursing and Medical Care University, Yokkaichi, Mie, Japan
  3. 3Department of Dermatology, Shimada General Medical Center, Shimada, Shizuoka, Japan
  4. 4Department of Hematology, Shimada General Medical Center, Shimada, Shizuoka, Japan
  5. 5Department of Diagnostic Pathology, Shimada General Medical Center, Shimada, Shizuoka, Japan
  1. Correspondence to Dr Yutaka Tsutsumi; pathos223{at}kind.ocn.ne.jp

Abstract

A woman in her 80s reported of generalised pruritus, which was treated with phototherapy and steroid administration. Two months after onset, lymph node biopsy revealed CD4+ angioimmunoblastic T-cell lymphoma with systemic superficial nodal involvement. Intractable prurigo was judged as T-cell lymphoma related. After effective chemotherapy (7 months later), skin nodules appeared multifocally, including on the lip, thumb and lower leg. The biopsied infiltrative lesion on the right lower leg microscopically revealed subcutaneous growth of atypical plasmablasts with nearly 100% Ki-67 labelling and Epstein-Barr virus (EBV)-encoded small nuclear RNA positivity. Plasmablastic lymphoma (CD45/CD19/CD38/CD138/MUM1+, CD20/CD79a/PAX5-) was suspected. Immunoglobulin light-chain restriction and nuclear expression of c-myc protein were undetectable, and the ulcers were spontaneously epithelialised by the cessation of steroid administration. After 10 months, non-progressive prurigos persisted on the extremities, but without regrowth of nodal T-cell lymphoma and cutaneous lymphoproliferative lesion. Reactive nature of the EBV-induced mucocutaneous plasmablastic growth (EBV-positive mucocutaneous ulcer, plasmablastic type) is discussed.

  • Pathology
  • Malignant and Benign haematology
  • Dermatology
  • Immunology

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Footnotes

  • Contributors Each author has sufficiently participated in the work to take public responsibility for appropriate portions of the content. YT and MT performed histopathological diagnosis, analysed the data and made a major contribution to writing the manuscript. SK and SY contributed to the care and therapy of the present case. SK had an excellent clinical sense to recognise reactive nature of the skin lesion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.