A skin punch biopsy showed fragments of skin with extensive lymphoid infiltrates (Fig.1, A; x20 objective, hematoxylin and eosin [H&E] stain). The initial lymphoma workup by immunohistochemistry demonstrated negative staining for CD45 (Fig. 1, B; x20 objective), CD3 (Fig.1, C; x20 objective), and CD20 (Fig. 1, D; x20 objective). Additional stains were performed which revealed the atypical lymphoid infiltrate to be positive for PAX5 (Fig 1, E; x20 objective), TdT (Fig 1, F; x20 objective), CD10 (Fig 1, G; x20 objective), and CD34 (Fig 1, H; x20 objective)