Spontaneously regressing papules and nodules with alarming histology

A 70-year-old man presented with an erythematous, eroded, mobile nodule, 20 mm in size, on his left jaw line. Biopsy showed features of T-cell lymphoma, with markedly epidermotropic, small to medium-sized, pleomorphic CD45+, CD3+, CD8+, CD30+, CD4 , CD5 , CD56 lymphocytes with high proliferation fraction (Ki-67 60%), cytotoxic marker expression and polyclonal T-cell receptor (TCR) re-arrangement. An expert haematopathologist favoured aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma over transformed CD8+ mycosis fungoides and cutaneous anaplastic large cell lymphoma (c-ALCL), but advised clinicopathological correlation. There was no evidence of extracutaneous involvement. The patient received local radiotherapy. Six months later, a further chest wall nodule was biopsied and reported by a local haematopathologist as primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma. The lesion resolved spontaneously following biopsy. The patient remained systemically well with no progression over 1 years. He was then listed for excision of a new erythematous scaly nodule on his right hip (Fig. 1). By the time the patient attended for excision 6 weeks later, the lesion had spontaneously regressed, and a biopsy was taken instead from a new nodule in the right groin. Histological findings