Cutaneous T-Cell Tumor

Daniel S. Berger, MD

A 39-year-old man with HIV infection was being treated with antiretroviral therapy. He now sought help for multiple 2- to 3-cm violaceous papules on his right hip and the right lower abdominal area. A biopsy specimen showed intense, atypical lymphocytoid and monocytoid cells with prominent nucleoli, hyperchromatism, and bruised nuclei.

A 39-year-old man with HIV infection was being treated with antiretroviral therapy. He now sought help for multiple 2- to 3-cm violaceous papules on his right hip and the right lower abdominal area. A biopsy specimen showed intense, atypical lymphocytoid and monocytoid cells with prominent nucleoli, hyperchromatism, and bruised nuclei. The vessels showed marked proliferation and invasion by the lymphocytoid cells, all of which is consistent with the diagnosis of a lymphoma similar to angioimmunoblastic lymphadenopathy with dysproteinemia. The tumor cells were negative for L-26 (a B-cell marker) and positive for UCHL-1 and CD43 (T-cell markers) and for leukocyte common antigen, all factors that indicate a T-cell tumor.

Cutaneous T-cell lymphomas typically begin with slowly progressive involvement of the skin, but they eventually involve lymph nodes and extracutaneous sites. Other examples include mycosis fungoides, occurring as extracutaneous patches, plaques, and/or tumors; and Szary syndrome, manifested as generalized erythroderma with malignant cells in the bloodstream.