Case of Panniculitis like T-cell Lymphoma

Abstract

Published widely as an author or co-author of more than 100 studies, Dr. Foss serves on the editorial board for the journal Clinical Lymphoma, and is a reviewer for the New England Journal of Medicine, Journal of Clinical Oncology, Blood, Journal of American Academy of Dermatology and Cancer. Dr. Foss has been a member of numerous professional societies, including the American Medical Association, the American College of Physicians, the American Society of Clinical Oncology, and the American Association for Cancer Research. Dr. Foss received her bachelor’s degree from Dartmouth University and her medical degree from the University of Massachusetts Medical School. She completed her internship and residency at Brigham and Women’s Hospital in Boston, Massachusetts. INITIAL PRESENTATION A 39 year old man presented with the sudden onset of a 10 centimeter mass in the left thigh which was slightly tender to palpation. He was initially treated with a course of oral antibiotics without improvement. As the original mass began to slowly regress over the next several months, the patient noted the appearance of several additional subcutaneous nodules in the bilateral lower extremities. The nodules persisted and slowly enlarged in size. He was otherwise healthy with no weight loss, fevers, chills, or other symptoms, and he continued to work full time. STAGING WORK-UP – CONSIDERATIONS FOR THE DERM/ONC FROM THE REFERRING PHYSICIAN Although he presented to his primary care physician for evaluation, he was referred to the CTCL clinic at Yale for further evaluation and staging by a multi-disciplinary team. His past medical history was significant for a 10 year history of idiopathic thrombocytopenia and mild splenomegaly felt to be a complication of previous mononucleosis. HISTOLOGY Excisional biopsy of one of these nodules revealed an atypical lymphoid infiltrate with a panniculitic distribution that focally extended into the deep dermis. The infiltrate was composed of variably-sized lymphocytes ranging from small to large that also show significant cytological atypia (Figure 1). Case of Panniculitis like T-cell Lymphoma