25-years old male patient was admitted with multiple
lymphadenopathies and skin lesions to the Hacettepe University
Hospital. Blood sedimentation rate was 82 mm/h
(0-20) and â2-microglobulin serum level was elevated,
2313 ng/mL (1010-1730). Abdomen and thorax computerized
tomography (CT) scans were done. Paraaortic, mesenteric
and mediastinal multiple lymphadenopathies were
detected. Biopsy from bone marrow was normocellular
without involvement with neoplastic infiltration. Subsequently,
skin punch biopsy of skin lesions and lymph
node biopsy from inguinal lymph node were performed.
The microscopic examination of skin punch biopsy
showed dermal and subcutaneous tissues infiltrated with
neoplastic cells which displayed small to medium-sized
cells with fine chromatin and scant cytoplasm and frequent
mitotic /apoptotic figures. Epidermis was intact. Immunohistochemical
studies revealed that these neoplastic cells
were diffusely positive with CD2, CD8, focally positive
with CD5 and terminal transferase (TdT) (Figure 1).
Figure 1: (A&B&C). Skin punch biopsy. (A): Blastic infiltration in superficial and deep dermis in the H&E sections, (B): Epidermis is
not involved by blastic infiltrate, (C): Monotonous neoplastic cells among dermal collagen and CD2 expression (insert)
In the lymph node biopsy sections, normal architecture
was effaced due to diffuse infiltration with monotonous
population of cells with starry-sky pattern. Touch imprint
showed cytological details of blastic cells. Immunohistochemical studies showed membraneous CD2, nuclear
TdT and high Ki-67 labelling (Figure 2).
Figure 2: (A-F). Lymph node biopsy. (A): Touch imprints show blastic cells, (B&C): H&E staining demonstrates diffuse blastic
infiltration in the lymph node, (D-F): Immunohistochemical staining shows membranous CD2, nuclear TdT, and Ki-67 positivity,
What is your diagnosis?
Precursor T-lymphoblastic leukaemia/lymphoma, skin
and lymph node.