An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma

Abstract

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a very rare form of skin lymphoma that is localized primarily to the subcutaneous adipose tissue without palpable involvement of the lymph nodes. Diagnosis of SPTCL is a challenge, especially during its early phases when symptoms mimic other, more common conditions, such as benign panniculitis, eczema, dermatitis, psoriasis and cellulitis. Clinical and systemic features are nonspecific and can include fever, chills, and weight loss. Further complicating diagnosis is the high number of false negatives provided by biopsy. Here we present a case of SPTCL that illustrates the full course of the disease, from presentation and multiple misdiagnoses to correct disease recognition and successful treatment. A review of the challenges of diagnosis is provided with recommendations for more accurate and timely recognition of SPTCL.

A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis

“…They are diseases of young adults, with a median age at diagnosis 30–40 years. There is a female preponderance and it accounts for less than 1% of non-Hodgkin lymphoma cases [ 3 ]. Patients usually present with multiple, painless subcutaneous plaques or nodules mostly on the trunk and extremities.…”

“…It can be accompanied by systemic symptoms of fevers, chills, night sweats, weight loss, and myalgias [ 4 ]. The differential diagnosis includes eczema, psoriasis, dermatitis, cellulitis, or lupus erythematosus panniculitis (LEP) [ 3 ]. Up to 20% of patients have an associated autoimmune disease such as systemic lupus erythematosus [ 5 ].…”

A dramatic presentation of an unusual form of cutaneous lymphoma

“…[ 3 4 5 ] Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) typically presents as multiple, painless, subcutaneous nodules that resolve and then reappear in varying skin locations. As such, it is commonly misdiagnosed as benign panniculitis, dermatitis, eczema and psoriasis[ 6 ] resulting in delay of appropriate treatment and poor outcomes. In this unique case, the condition manifested as a dramatic and florid purpuric dermatosis with large spreading rings on the patient's trunk.…”

Tender Soft Tissue Mass on the Base of the Neck

“…1,3 Current guidelines denote that SPTCL T-cell receptor (TCR) αβ is a distinct entity from the TCRγδ phenotype, known as cutaneous γδ-positive T-cell lymphoma. 3,4 Cutaneous γδ-positive T-cell lymphoma is associated with rapid decline and a worse prognosis. 4 Histology of SPTCL is characteristic for a lobular panniculitislike infiltrate.…”

“…3,4 Cutaneous γδ-positive T-cell lymphoma is associated with rapid decline and a worse prognosis. 4 Histology of SPTCL is characteristic for a lobular panniculitislike infiltrate. 1 The heavy subcutaneous lymphoid infiltrate is composed of atypical small-to medium-sized lymphocytes with mature chromatin and inconspicuous nucleoli lining adipocytes.…”