Case Number : Case 961 - 27th February Posted By: Guest

Epidermotropic lymphoma. Possibly mycosis fungoides, tumour stage + transformation.

I agree with Dr Abdul-Kadir. However, would like to exclude adult T cell leukaemia/lymphoma before suggesting MF. Immuno including CD25 would be essential. Has the patient been investigated for HTLV1?

Epidermotropic lymphoma, probably some kind of T-cell Lymphoma. The lesions are located in a typical location for MF, the age is also typical and there´s more than 25% of large cells in the infiltrate, so I think this is probably MF with blastic transformation.
Clinical history is essential. If the patient had this lesion for some years, maybe associated with plaques or patches, it must be MF. If this lesion is of rapid onset, could be CD8+ epidermotropic agressive T-cell cutaneous lymphoma. Adult T cell leukemia/lymphoma is also a good hypothesis.
Do not forget that if these lesions were recurrent papules with crust formation this case could be Type B Lymphomatoid Papulosis.
Rare cases of B-cell lymphoma are epidermotropic. Always necessary histology, clinical information and immunoprofile for a correct diagnosis.

Tumor stage MF with large cell transformation.

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Agree with the above excellent differentials and need for stains. Very high mitotic activity with some immunoblastic features.
I would favor ALCL.

Agree with the differentials, Immunos are mandatory..

This was mycosis fungoides with large cell transformation. CD4 positivity was much greater than CD8. The large cells were CD30 positive. Clinically the patient had the full spectrum of lesions (patches, plaques and tumors).

Dra. Halim have recommeded an excellent article about this issue in the [url="https://dermpathpro.com/index.html/_/latest-news/large-cell-transformation-of-mycosis-fungoides-r53"]News section[/url].