Cutaneous multilobated T-cell lymphoma with aggressive course

Multilobated T-cell lymphoma is a malignancy of the lymphoid tissue characterized by abnormal immune T-cells, which contain nuclei with many lobes. The chromatin, or structures within the nucleus, tend to be fine, whereas the nucleoli (round structures made up of dense fibers and granules) tend to be very small or undetectable. The multilobated form of peripheral T-cell lymphoma (PTL) often affects sites other than the lymph nodes, such as the skin and bone. Twenty-eight percent of patients with multilobated PTL have skin complications. However, the skin is rarely the primary tissue involved in multilobated PTL, and less than 20 cases of cutaneous (skin-related) multilobated T-cell lymphoma have been reported. Cutaneous multilobated T-cell lymphoma (CMTCL) is usually a chronic disease with a favorable outcome. A case is described of a 74-year-old man who developed CMTCL, which progressed rapidly to death within two years after the onset of disease. The patient had a history of diabetes and severe disease of the coronary arteries, the major blood vessels supplying the heart. A large ulcer on the right leg and enlarged lymph nodes in the right groin area were noted. Microscopic examination of tissue samples from the ulcer and affected lymph nodes confirmed the diagnosis of CMTCL, which was successfully treated with radiation. However, five months later, the patient developed fever, night sweats, and enlargement of the lymph nodes and spleen. He was diagnosed with angioimmunoblastic lymphadenopathy, a disease of the lymph nodes, and was treated with cyclophosphamide, vincristine, and prednisone. Violet-colored, solid, round skin lesions on the right thigh developed, which resolved after radiation treatment. A year later, the patient developed reddish patches on his body and enlarged lymph nodes in the groin area. Despite treatment with cyclophosphamide, vincristine, and prednisone, the disease spread to the lungs, liver, spleen, bones, and bone marrow, and the patient died five months later. This case shows that CMTCL can progress rapidly to a fatal outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)