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Cutaneous T-cell lymphoma
*For correspondence: ajaygogia@gmail.com
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Received: ,
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 47 yr old male† presented to the Medical Oncology department, All India Institute of Medical Sciences, New Delhi, India, in March 2019, with a four-month history of multiple pruritic plaque-like lesions over the body. On physical examination, multiple hyper-pigmented plaques, papules and tumours were seen over the trunk and limbs (including palms and soles) (Fig. 1A and B). Biopsy from the plaque lesion revealed a dense infiltrate of atypical lymphocytes, histiocytes and eosinophils in the dermis. There was marked epidermotropism (Fig. 2A) along with intra-epidermal Pautrier's microabscesses (Fig. 2B). On immunohistochemistry, the lymphocytes were positive for CD3 (Fig. 2C) and CD4 but negative for CD7, CD20 and CD30. Subsequent positron-emission tomography-computed tomography scan showed multiple metabolically active cutaneous soft tissue nodules (data not shown). Peripheral smear and bone marrow aspirate were normal.
- (A and B) Photograph of the trunk, upper limbs and soles of feet showing multiple plaques (green arrow), tumours (red arrow) and ulcers (blue arrow).
- (A) Histopathology of the plaque lesion showing atypical lymphoid cells with epidermotropism (inside the rectangle) (H and E, ×100) and (B) Pautrier's microabcesses (black arrows) (H and E, ×200). (C) Immunohistochemistry of the plaque biopsy showing positivity for CD3 (inside the circle) (×200).
A diagnosis of mycosis fungoides (T3N0M0B0 - Stage IIB) was made, the patient was initially managed with oral methotrexate 25 mg per week. After transient improvement for three months, there was a relapse of skin lesions. At this point, total skin electron beam therapy with topical steroids followed by chemotherapy with liposomal doxorubicin 30 mg/m2 every four weeks was administered. Upon eight months of follow up the patient has completed three doses and has had good clinical response (Fig. 3A and B).
- Post-therapy clinical photograph showing partial regression of skin lesions on the (A) trunk and (B) soles of feet.
Acknowledgment:
Authors thank Drs Sudheer Kumar Arava and Saumyaranjan Mallick, department of Pathology, AIIMS, New Delhi, for providing histopathology images and their interpretation.
Conflicts of Interest: None.
