CUTANEOUS MALACOPLAKIA SIMULATING RELAPSING MALIGNANT-LYMPHOMA

This report describes the case of a 42‐year‐old man with malignant lymphoma, diffuse large non‐cleaved cell type, who developed cutaneous malakoplakia in the left groin. The patient had widespread lymph node involvement, including a left inguinal mass which was clinically thought to represent recurrent lymphoma. The inguinal mass failed to regress after chemotherapy and irradiation, although lymphoma in other sites responded to chemotherapy. A skin biopsy of the area showed an ulcer and an abscess involving the dermis and subcutaneous tissue. Microscopically, a diffuse infiltrate of foamy histiocytes was seen with numerous intracellular and extracellular, round and laminated bodies. Some of these bodies had a “targetoid” appearance, stained strongly with von‐Kossa's calcium stain and showed the typical appearance of Michaelis‐Gutmann bodies by electron microscopy. Cultured monocytes from the peripheral blood of the patient showed ultrastructural features similar to their tissue counterparts, suggesting a systemic involvement of the monocyte macrophage lineage. This case represents an unusual presentation of malakoplakia of the skin associated with relapsing malignant lymphoma in a patient on immunosuppressive drugs. Copyright © 1990, Wiley Blackwell. All rights reserved