Journal Article

Rare type A lymphomatoid papulosis initially presenting as a giant ulcer: a case report and literature review

Jia, Yuxi, Chen, Xiangru, Zhao, Jingtong, An, Lin, Zhang, Qingling

2025

Overview

Lymphomatoid papulosis (LyP) is a rare, chronic, recurrent, self-healing, indolent cutaneous lymphoproliferative disorder. Histologically, it resembles malignant lymphoma; however, its clinical manifestations are predominantly characterized by benign behaviors, including recurrent papules, nodules, and necrotic lesions. We report a case of a middle-aged female who initially presented with a giant ulcer on the right foot and was surgically treated at another hospital as a keratoacanthoma (KA). Over subsequent months, she developed scattered papules and nodules on the trunk and limbs. A comprehensive clinical and histopathological reassessment confirmed a diagnosis of LyP Type A. Notably, the initial ulcerative lesion represented an atypical feature of LyP rather than a conventional KA. Finally, the patient was successfully treated with methotrexate and interferon, resulting in complete resolution of the skin lesions without recurrence. In summary, this case highlights that a giant ulcer exhibiting pseudoepitheliomatous hyperplasia (PEH) in histopathology may indicate LyP. Careful assessment for atypical lymphocytic infiltration and further immunohistochemical evaluation are essential for accurate diagnosis. When single clinical or histopathological findings are insufficient to provide a comprehensive understanding of the disease, thorough evaluation and dynamic monitoring are critical for diagnosing and managing complex cases.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Blood tests / Case reports / Dermatology / Diagnosis / Diagnosis, Differential / Disease / Female / giant ulcer / Hospitals / Humans / Hyperplasia / Immunology / keratoacanthoma / Lesions / Literature reviews / Lymphocytes / Lymphoma / Lymphomatoid papulosis / Lymphomatoid Papulosis - diagnosis / Lymphomatoid Papulosis - drug therapy / Lymphomatoid Papulosis - pathology / Methotrexate / Methotrexate - therapeutic use / Middle Aged / Neutrophils / Nodules / pseudoepitheliomatous hyperplasia / Skin / Skin diseases / Skin lesions / Skin Neoplasms - diagnosis / Skin Neoplasms - drug therapy / Skin Neoplasms - pathology / Skin Ulcer - diagnosis / Skin Ulcer - etiology / Skin Ulcer - pathology / Surgery / Ulcers / Ultrasonic imaging