Volume 2, Issue 5, Pages (September 2016)

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Volume 2, Issue 5, Pages 390-396 (September 2016) CD56− extranodal natural killer (NK)/T-cell lymphoma, nasal type presenting as skin ulcers in a white man Charles Vainder, MD, Jonhan Ho, MD, Steven H. Swerdlow, MD, Oleg E. Akilov, MD, PhD JAAD Case Reports Volume 2, Issue 5, Pages 390-396 (September 2016) DOI: 10.1016/j.jdcr.2016.05.020 Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Extranodal NK-T cell presenting with rapidly expanding cutaneous ulcers in a previously healthy man. JAAD Case Reports 2016 2, 390-396DOI: (10.1016/j.jdcr.2016.05.020) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Biopsy from the left elbow. Hematoxylin-eosin stain shows a diffuse superficial and deep dermal infiltrate centered around skin appendages and blood vessels on a scanning (A) and close-up (B) magnification. A thinned epidermis with impending ulcer with a large area of necrosis, lymphocyte exocytosis, basal vacuolization, and Civatte bodies (C). Sheets of monotonous medium-sized cells with hyperchromatic nuclei and included numerous large atypical lymphocytes (D). JAAD Case Reports 2016 2, 390-396DOI: (10.1016/j.jdcr.2016.05.020) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Immunohistochemical staining for CD3 (A), CD20 (B), CD4 (C), CD8 (D), CD43 (E), CD2 (F), CD5 (G), CD7 (H), EBER (I), Ki-67 (J), CD56 (K), granzyme B (L). CD2, CD3, CD43, Ki-67, EBER and granzyme B stain strongly. CD4, CD5, CD7, CD8 are somewhat diminished compared with CD2 and CD3 staining. CD56 is completely absent. JAAD Case Reports 2016 2, 390-396DOI: (10.1016/j.jdcr.2016.05.020) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 PET/CT scan image shows avid uptake in the tonsils, right axilla, and left calf. JAAD Case Reports 2016 2, 390-396DOI: (10.1016/j.jdcr.2016.05.020) Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions