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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 48-49

Cutaneous T-cell lymphoma


Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110 029, India

Date of Submission15-Oct-2019
Date of Web Publication25-May-2021

Correspondence Address:
Ajay Gogia
Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1792_19

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How to cite this article:
Arora S, Gogia A. Cutaneous T-cell lymphoma. Indian J Med Res 2020;152, Suppl S1:48-9

How to cite this URL:
Arora S, Gogia A. Cutaneous T-cell lymphoma. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:48-9. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/48/316731

Patient's consent obtained to publish clinical information and images.


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) [Figure 1]A and [Figure 1]B. Biopsy from the plaque lesion revealed a dense infiltrate of atypical lymphocytes, histiocytes and eosinophils in the dermis. There was marked epidermotropism [Figure 2]A along with intra-epidermal Pautrier's microabscesses [Figure 2]B. On immunohistochemistry, the lymphocytes were positive for CD3 [Figure 2]C 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.
Figure 1: (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).

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Figure 2: (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).

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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 [Figure 3]A and [Figure 3]B.
Figure 3: Post-therapy clinical photograph showing partial regression of skin lesions on the (A) trunk and (B) soles of feet.

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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.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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