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Aggressive Peripheral T‐cell Lymphoma Presenting as Cutaneous Nodules with a Dense Infiltrate of Eosinophils
Author(s) -
High W.A.,
Houpt K.R.,
Hoang M.P.,
Cockerell C.J.,
Kroft S.H.
Publication year - 2005
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2005.320cp.x
Subject(s) - pathology , medicine , nodule (geology) , cd30 , lymphoma , biopsy , cd8 , skin biopsy , atypical lymphocyte , population , immunology , antigen , biology , paleontology , environmental health
A 65 year‐old, well‐appearing and asymptomatic man presented with a small non‐healing ulcer on the right palm present for 6 weeks. He reported a 15 year history of hand and foot “eczema” treated with topical steroids. Six months earlier his right 4th toe had been amputated for “infection”, but additional information was not immediately forthcoming. Punch biopsy from the palm demonstrated superficial ulceration, dermal eosinophils and possible cytoplasmic inclusions within keratinocytes, leading to suspicion of parapox infection. Over the ensuing two months his condition deteriorated markedly, and he developed multiple fungated and ulcerated cutaneous nodules. Incisional biopsy of the nodule on the right palm revealed a dense dermal inflammatory infiltrate with a predominance of eosinophils, and a perivascular infiltrate of medium to large lymphocytes with irregular nuclei and mitoses. These atypical lymphocytes were positive for CD3, but were negative for CD4, CD8, CD30, CD56, TIA‐1 and EBER in‐situ hybridization. TCR‐gamma gene rearrangement revealed a clonal population. Retrospective analysis of the amputated toe demonstrated similar features. He declined conventional treatment, and has been reluctant to pursue follow‐up. Our case highlights the fulminant course and dense mixed inflammatory cell infiltrate with eosinophils often present in peripheral T‐cell lymphoma that may complicate diagnosis.