The patient was a 50 y/o female with skin lesions, flushing and diarrhea, hepatosplenomegaly, anemia, and thrombocytopenia. Splenectomy specimen showed prominent follicles. Flow cytometry showed the following profile: Positive: CD2, CD9, CD25, CD68, CD117 and tryptase; Negative: CD3, CD4, CD20, and CD34. The diagnosis was Systemic mastocytosis. The photomicrograph shows ill-defined, fibrotic, granuloma-like nodules.