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.