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Background
Cutane~us
T-cell lymphoma (CTCL) has a variable
presentation and comprises a broad diagnostic group.
Histologic and immunophenotypic confirmation is
needed to establish a precise diagnosis. Once the
categorization
is determined,
prognosis
and
therapeutic algorithms unfold. Primary cutaneous,
CD-30+, Anaplastic
large T-cell lymphoma
represents an indolent form of CTCL that often
spontaneously involutes. CTCL is a broad diagnosis
encompassing a spectrum of disease. The European
Organization for Research and Treatment of Cancer
(EORTC) Cutaneous Lymphoma Project recognizes
mycosis fungoides (MF), cutaneous CD30-positive
large-cell lymphoma, and lymphomatoid papulosis
as CTCLs with indolent clinical behavior [1]. Clinical
presentation and immunohistochemistry together are
needed to determine the subtype of CTCL, which
guides proper management.
Clinical Synopsis
Case No.1
This 47 year old lady presented with history of
swelling over left armpit and breast since one and
half year, burning pain over left breast since 2 months
and weight-loss since 4 months. Comorbidity:
Hypothyroidism.
Considering
axillary
lymphadenopathy, strongly positive Monteux test
with history of weight loss of 6 kg 54 to 48 kg in 4
months, she was started on antituberculous therapy
w.e.f. Nov 2010. In July 2011 (after 8 months), she
came to INHS ASVINI for increase in number of
months on Isoniazide+Rifampicin.
She was
investigated with MTB- PCR; found to be negative
hence A IT was stopped. Of late, she developed
erythematous lesions over left breast which was itchy
painful and gradually increasing in size to form an
ulcer. Similar lesions developed over axilla and
breasts over a period of 6 weeks. For next 15 days
she had increasing burning pain disturbing her sleep
and appearance of similar lesion on trunk made her
"Resident, Department of Medicine; 'Senior Advisor (Medicine & Oncology), INHS ASVINI, Colaba, Mumbai400005; cProfessor & Head, Department of Surgery, ESI Post Graduate Institute of Medical Science &
Research, Mahatma Gandhi Memorial Hospital, Parel, Mumbai - 400012. "Senior Advisor Dermatology,
eClassifIed Specialist Radiation Oncology, Consulrant Pathology, INHS ASVINI Colaba, Mumbai - 400 005.
"Corresponding author: Email-manojmore4@gmail.com.
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Discussion
Recently the World Health Organization (WHO)
and European Organization for Research and
Treatment of Cancer Classification (EORTC) [11,
12] reached a consensus classification for cutaneous
lymphomas and revised by WHO in 2008. Cutaneous
T-cell lymphomas are subdivided into the following
classifications.
Mycosis fungoides is the most common type of
CTCL and accounts for almost 50% of all primary
cutaneous lymphomas. The second most common
group of CTCL is primary cutaneous CD30+
lymphoproliferative disorders. Primary cutaneous,
CD30-positive, large-cell lymphoma represents
about 10 percent of all cases ofCTCL [1]. Primary
cutaneous CD30-positive large cell lymphoma is
defmed according to the following criteria [2, 3] :
1. No clinical evidence oflymphomatoid papulosis
2. No previous or concurrent lymphomatoid
papulosis, mycosis fungo ides, or other
(cutaneous) lymphoma
3. No extracutaneous localization at presentation
4.
:
I'
Source of support
Nil
"_
Conflict(of interest
All authors have none to Declare.
References
1.
2.
3.
4.
5.
6.
7.
Willemze R, Meijer CJLM. Primary cutaneous CD30positive lymphoproliferative disorders. Hematol Oncol Clin
N Am 2003;17: 1319-32. PubMed
8.
9.
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