|Year : 1997 | Volume
| Issue : 6 | Page : 370-372
Unusual presentation of T-cell lymphoma
J Mona Pandya, C Ranjan Rawal, FE Bilimoria
J Mona Pandya
Source of Support: None, Conflict of Interest: None
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 2020 Jun 6];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  In 1885, Vidal and Brocq  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.  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 . 
| Case Report|| |
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|| |
In the present case initially patient had history of bullous eruptions followed by papules, plaques and erythema multiforme - like lesions  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  Rarity of the disease and atypical manifestations observed persuaded us to report this case.
| References|| |
|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. |
|2.||Vidal E, Brocq L.Etude sur le mycosis fungoides La France Medical 1885; 2: 946-1085. |
|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. [PUBMED] |
|4.||Roenigk H H, Castrovinci A J. Mycosis fungoides bullosa. Arch Dermatol 1971; 104: 402-406. |
|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. |
[Figure - 1], [Figure - 2]