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CASE REPORT
Year : 1997  |  Volume : 63  |  Issue : 6  |  Page : 370-372

Unusual presentation of T-cell lymphoma




Correspondence Address:
J Mona Pandya


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Source of Support: None, Conflict of Interest: None


PMID: 20944382

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  Abstract 

A 56-year old woman developed multiple papules, plaques and erythema - multiforme (EM) like lesions on palms, soles, abdomen, back, axillary and gluteal folds of one month duration. She also had erythematous plaques, painful necrotising ulcers and oro-genital ulcerations. Skin biopsy was suggestive of plaque stage of cutaneous T-cell lymphoma.


Keywords: T-cell lymphoma, Lymphoma, Erythema multiforme


How to cite this article:
Pandya J M, Rawal C R, Bilimoria F E. Unusual presentation of T-cell lymphoma. Indian J Dermatol Venereol Leprol 1997;63:370-2

How to cite this URL:
Pandya J M, Rawal C R, Bilimoria F E. Unusual presentation of T-cell lymphoma. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Sep 17];63:370-2. Available from: http://www.ijdvl.com/text.asp?1997/63/6/370/4621


The cutaneous lymphomas form a wide spec­trum of skin disorders with clinical presen­tations and courses that vary widely [1] In 1885, Vidal and Brocq [2] described "sudden" devel­opment of tumours without a long progres­sion through the precursor stage and called the condition "mycosis fungoides d'emblee". A second recently recognised T-cell lymphoma with frequent cutaneous involve­ment is the Pinkus tumour. [3] In the tumour stage, nodules usually appear in infiltrated plaques and these masses have a predilection for the face and body folds. Gradually the tumours may become generalised, ulcerate and become secondarily infected. Oral manifestations are also rare and usually occur during dissemination of the disease . [4]


  Case Report Top


A 56-year-old woman presented with mul­tiple papules, plaques and erythema multiforme like lesions on the palms, sole, abdomen, back, axillary and gluteal folds of one month duration. she also developed erythematous plaques and necrotising ulcers over chest, lower abdomen and legs. She had painful oral ulcerations on the pal­ate, tongue and buccal mucosa and genitals. She gave history of bullous and ulcerative lesions in the axillary and gluteal folds one year back, that responded partially to steroid therapy. She also had history of recurrent herpes labialis.

Examination revealed erythematous papules, plaques and erythema multiforme - like target lesions on the palms, soles, abdomen, and face [Figure - 1], back, axillary and gluteal folds. Necrotising ulcers were seen on the face, abdo­men and back [Figure - 2], legs, axilla and crural folds. There was no significant lymphadenopathy. Oral lesions resembled aphthae.

Her blood HB was 9.6gm%, TC : 18600/ cu.mm and D.C.: 68/28/02/02% E.S.R. was 10 mm Ist h Blood urea, sugar, creatinine and electrolyte levels were within the nor­mal range. Ultra sonography of the abdomen revealed constricted gall bladder. ECG and x-ray of the chest were normal. Mantoux test and Tzanck smear for acantholytic cells were negative. Skin biopsy was suggestive of plaque stage of cutaneous T-cell lymphoma.

The epidermis showed mild psoriasiform hyperplasia and was infiltrated by lympho­cytes in absence of significant spongiosis (Dolly part on sign.). There was vacuolization of the basal layer and the lymphocytes were lined up in the basal layer like toy soldiers (Toy soldier sign.). The dermis showed mod­erately dense lichenoid infiltrate of small and large lymphocytes, some of which were of irregular shape.

Patient was treated with 80 - 100 mg., of prednisolone and cefotaxime 2gms bid, but the response was poor and the new lesions continued to appear. Patient was referred to cancer Hospital, Ahmedabad, where she was treated with bolus dose of cyclophospha­mide., vincristin and prednisolone. The lesions regressed after first bolus dose. Second bolus dose was given after a month but after two weeks patient developed florid lesions. So doxorubicin was added to bolus therapy. Inspite of that patient did not show significant improvement. The same regimen was repeated after a month following which she developed severe leucopenia, septicemia and hypotension. Patient expired after two days.


  Discussion Top


In the present case initially patient had his­tory of bullous eruptions followed by papules, plaques and erythema multiforme - like lesions [5] Rarely the clinical features of the T­ cell lymphoma lesions may be atypical and initial appearance has been reported in an individual as acneiform, bullous, papillomatous and hypopigmented lesions 6 Another unusual feature in our patient was persistent oral lesions. Wright et al also had described aphthae - like oral lesions in cuta­neous T-cell lymphoma [4] Rarity of the disease and atypical manifesta­tions observed persuaded us to report this case.

 
  References Top

1.Kurban R S, Safai B. Cutaneous T-cel lymphoma In : Cancer of the Skin, Friedman R J, Darrell S, Rigel D S, et al. eds WB Saunders Company, Philadelphia, 1991, 39-346.  Back to cited text no. 1    
2.Vidal E, Brocq L.Etude sur le mycosis fungoides La France Medical 1885; 2: 946-1085.  Back to cited text no. 2    
3.Pinkus GS, Said JW, Hargreaves H. Malignant lymphoma T-cell type. A distinct morphologic variant with large multilobulated nuclei, with a report of four cases. Am J Clin Pathol 1979; 72: 540-550.  Back to cited text no. 3  [PUBMED]  
4.Roenigk H H, Castrovinci A J. Mycosis fungoides bullosa. Arch Dermatol 1971; 104: 402-406.  Back to cited text no. 4    
5.Blasik L B, Newkirk R E, Dimond R L, et al. Mycosis fungoides d'emblee; A rare presentation of cutane­ous T-cell lymphoma. Cancer 1982, 49: 742-747.  Back to cited text no. 5    


    Figures

[Figure - 1], [Figure - 2]



 

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