Brand-Ad-30-6
 IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 6075 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   Article in PDF (108 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Case report
   Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed6245    
    Printed115    
    Emailed1    
    PDF Downloaded155    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
CASE REPORT
Year : 2006  |  Volume : 72  |  Issue : 3  |  Page : 215-217

CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement


1 Departments of Dermatology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
2 Departments of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India

Correspondence Address:
Raghunatha R Reddy
Department of Dermatology, Sri Devaraj Urs Medical College, Tamaka, Kolar 563 101, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.25783

Rights and Permissions

  Abstract 

A 40-year-old previously healthy lady presented with nasal obstruction and localized plaques over the right arm. She developed complete nasal obstruction due to a mass in the right nasal cavity and skin lesions that ulcerated to present as ecthyma gangrenosum like lesions. Patient's condition deteriorated fast and she developed icterus with fatal outcome within 4 weeks of developing skin lesions. Nasal and skin biopsy revealed angiocentric T-cell lymphoma, which on immuno-phenotyping revealed CD-3 positive; and CD-20, CD-30, ALK and EMA negativity. She was seronegative for HIV. Final diagnosis of CD-3 positive extranodal T-cell lymphoma of nasal type was made. Extranodal T-cell lymphomas are very aggressive NHLs with poor prognosis. Prognosis depends on histology, stage of the disease and sites of involvement. NK/T cell lymphoma of nasal type is common with EBV association. Skin involvement is rare and is also an indicator of poor prognosis.


Keywords: Angiocentric lymphoma, CD-3 positive, Extranodal T-cell lymphoma


How to cite this article:
Reddy RR, Singh G, Prathima K J, Harendra Kumar M L. CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement. Indian J Dermatol Venereol Leprol 2006;72:215-7

How to cite this URL:
Reddy RR, Singh G, Prathima K J, Harendra Kumar M L. CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement. Indian J Dermatol Venereol Leprol [serial online] 2006 [cited 2020 Oct 24];72:215-7. Available from: https://www.ijdvl.com/text.asp?2006/72/3/215/25783



  Introduction Top


Non-Hodgkin's lymphomas (NHLs) presenting as skin lesions are more commonly of B-cell phenotype, followed by T-cell phenotype and mycosis fungoides.[1] B-cell type of lymphomas in the category of extranodal type in the cervicofacial region are in greater majority than the T-cell type and most of them are associated with EBV infection and are more common in renal allograft patients.[2] Extranodal involvement - especially of skin, irrespective of the extent of involvement - is an important poor prognostic factor.[3] Though skin involvement is rare, it has been reported and a high index of suspicion is required for early diagnosis.

We report a case of CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement in a 40-year-old previously healthy lady, with rapid progression resulting in a fatal outcome.


  Case report Top


A 40-year-old lady presented with history of nasal obstruction, which gradually increased over a period of 4 months. She developed localized swelling and skin lesions over right arm with pain. Later she developed fever, icterus and the nasal obstruction worsened. She had no history of significant illness or surgery in the past. General physical examination was normal except for the presence of icterus and there was no regional lymphadenopathy. On examination, localized indurated, ill-defined plaques were seen over an erythematous base over the posteromedial aspect of the right arm, measuring approximately 8 cm x 10 cm in diameter. Subsequently, tenderness, necrosis, crusting and ulceration developed over the plaques [Figure - 1]. ENT examination revealed reddish mass in the right nasal cavity, adherent to the lateral wall and bleeding on touch. The same mass was seen in the nasopharynx on posterior rhinoscopy and a clinical diagnosis of nasopharyngeal carcinoma was made.

Following were the results on investigations: Hb - 9 gm%; total count - 5000 cells/mm 3; differential count: N - 82%, L - 15%, E - 02%, M - 01%; ESR - 80 mm/Hr; Blood culture - no yield; Mantoux test - negative; ELISA for HIV - negative; HbsAg - negative; serum bilirubin: total - 10.9 gm%, direct - 6.2 gm%. Ultrasound examination revealed mild hepatosplenomegaly with cholecystitis. CT scan revealed a mass in the nasopharynx extending to involve the skull base, right maxillary antrum and right nasal cavity.

Skin biopsy and endoscopic biopsy of the nasal mass showed groups and sheets of round to oval tumor cells with a vesicular nucleus and prominent nucleoli, admixed with mononuclear inflammatory cells. The tumor cells were infiltrating the vessel wall with destruction of the wall and areas of necrosis. A histopathological diagnosis of angiocentric lymphoma was made based on the above findings. Immunophenotyping of the same specimen revealed CD-3 positive; and CD-20, CD-30, ALK and EMA negativity; and a final diagnosis of extranodal CD-3 positive T-cell lymphoma of nasal type with skin involvement was made.

Three weeks after developing skin lesions and after debridement, she lapsed into semiconsciousness, later coma and died within 4 weeks after developing skin lesions.


  Discussion Top


Based on the above findings, this case was classified as extranodal peripheral T-cell lymphoma of nasal type, but EBV association could not be established and natural killer cell phenotype was not confirmed due to technical difficulties. Extranodal NK/T-cell lymphoma of nasal type has been defined in the recently proposed WHO classification of hemopoietic and lymphoid neoplasms. They are almost universally associated with EBV infection.[2] Most common localization of NK/T-cell lymphoma is in the head and neck region, especially the nasal cavity and it can also occur in other sites like skin and gonads.[2],[4] Histopathologically, they can be intermediate or high-grade malignancies and should be differentiated from squamous cell carcinomas due to their clinical similarity. Morphologically, they were previously termed as angiocentric lymphomas (Revised European-American Lymphoma classification).[5] Clinically, they are very aggressive neoplasms with poor prognosis.[2],[6]

This case resembles a recently described clinicopathological syndrome of fulminant T-cell lymphoproliferative disorder following acute/chronic EBV infection, characterized by fever, hepatosplenomegaly, pancytopenia, erythrophagocytosis and liver failure.[7]

NHLs presenting as skin lesions are more commonly of B-cell phenotype.[1] Presence of extranodal disease at the time of presentation is the most important clinical variable and portends a poor prognosis.[3]

Treatment consists of radiation and/or chemotherapy. Prognosis depends on histology, stage and site of lesion. Newer treatment strategies may lead to improved survival for patients with head and neck NHLs.[8]

This case is being reported due to its rarity, aggressive course, rapid fatality, skin and, probably, hepatic system involvement. A high degree of clinical suspicion and complete workup in a short span is required to diagnose this entity.

 
  References Top

1.Yaqoob N, Noorali S, Pervez S. Non-Hodgkin's lymphomas presenting as cutaneous lesions. J Coll Physicians Surg Pak 2003;13:29-32.  Back to cited text no. 1    
2.Stadlmann S, Fend F, Moser P, Obrist P, Greil R, Dirnhofer S. Epstein-Barr virus-associated NK/ T-cell lymphoma, nasal type of the nasopharynx, in a renal allograft recipient: case report and review of literature. Hum Pathol 2001;32:1264-8.  Back to cited text no. 2    
3.Mraz-Gernhard S, Natkunam Y, Hoppe RT, LeBoit P, Kohler S, Kim YH. Natural killer/ natural killer-like T-cell lymphoma, CD56+, presenting in the skin: an increasingly recognized entity with an aggressive course. J Clin Oncol 2001;19:2179-88.  Back to cited text no. 3    
4.Russel-Jones, Robin MA. World Health Organization classification of hematopoietic and lymphoid tissues: implications for dermatology. J Am Acad Dermatol 2003;48:3-102.  Back to cited text no. 4    
5.Slater DN. The new World Health Organization classification of haematopoietic and lymphoid tumors: a dermatopathological perspective. Br J Dermatol 2002;147:633-9.  Back to cited text no. 5    
6.Ansai S, Maeda K, Yamakawa M, Matsuda M, Saitoh S, Suwa S, et al . CD56- positive (nasal-type T/ NK cell) lymphoma arising on the skin. Report of two cases and review of literature. J Cutan Pathol 1997;24:468-76.  Back to cited text no. 6    
7.Quintanilla-Martinez L, Kumar S, Fend F, Reyes E, Teruya-Feldstein J, Kingma DW, et al . Fulminant EBV+ T-cell lynmphoproliferative disorder following acute/ chronic EBV infection: a distinct clinicopathological syndrome. Blood 2000;96:443-51.  Back to cited text no. 7    
8.Stenson KM, Wolf GT, Urba S. Extranodal non-Hodgkin's lymphoma of the head and neck: presentation in the facial bones. Am J Otolaryngol 1996;17:276-80.  Back to cited text no. 8    


    Figures

[Figure - 1]

This article has been cited by
1 Immunomorphologic profile and Epstein–Barr virus status of a cohort of 35 cases of extranodal natural killer/T-cell lymphoma, nasal type of upper aerodigestive tract from a tertiary care center in South India
Amit Bugalia,Marie Therese Manipadam,Sheila Nair
Leukemia & Lymphoma. 2013; 54(6): 1201
[Pubmed] | [DOI]
2 Extranodal NK/T-cell lymphoma, nasal type
Pazdro-Zastawny, K., Kuliszkiewicz-Janus, M.
Acta Haematologica Polonica. 2009; 40(4): 823-836
[Pubmed]
3 Nasal NK/T cell lymphoma presenting as a lethal midline granuloma
Mehta, V., Balachandran, C., Bhat, S., Geetha, V., Fernandes, D.
Indian Journal of Dermatology, Venereology and Leprology. 2008; 74(2): 145-147
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow