Subcutaneous panniculitis-like T-Cell lymphoma: A mixed diagnostic approach to diagnosing a vague clinical picture

Abstract

Subcutaneous panniculitis-like T-Cell lymphoma (SPTCL) is a rare subtype of cutaneous T-cell lymphoma, and it has been associated with a range of clinical symptoms from mild to severe. Most commonly, this disease is described as following a slowly progressing course, associated with vague constitutional symptoms and good prognosis. This case report describes the clinical presentation and findings of SPTCL in a 31 year old female and describes the challenges of recognizing and properly diagnosing this disease. SPTCL has been described as a mimicker of other, more common and nonmalignant diseases of the skin, such as lupus panniculitis. This report highlights a variety of specific tests including immunohistochemical and immunoperoxidase staining, as well as genotypic analysis of T-cell receptors, that were effective in combination in isolating this diagnosis. Moreover, choice of treatment for these patients can be challenging, as an array of interventions have been described in past cases to treat SPTCL. This report recognizes the efficacy of a treatment course that included a six-cycle course of combined chemotherapy (vincristine, doxurubicine, cyclophosphamide, and prednisone, also known as CHOP) followed by weekly methotrexate and PET scan surveillance for two years. With both initial and maintenance therapy, this patient showed excellence response evidenced by a progressive decrease in metabolic activity of malignant lesions, lack of new lesions, and remaining without symptoms. While this disease is rare, it is important to include SPTCL in the differential when considering patients with a panniculitic picture.

A unique case of subcutaneous panniculitis-like T-cell lymphoma presenting as an abscess following an arthropod bite

“…The initial presentation of SPTCL can mimic pyoderma and patients can present with features such as fever, erythema, and tender swelling. However, these persist despite courses of antibiotics with bacterial cultures returning sterile [2,10]. To the best of our knowledge, aside from the case reported herein, there are two other reports exemplifying how pseudo-pyoderma may be a pitfall in the diagnosis of SPTCL.…”

An unusual presentation of subcutaneous panniculitis‐like T‐cell lymphoma: Extensive necrosis and hemophagocytic lymphohistiocytosis: A case report

“…Unique to this case is the occurrence of nodules on the face and the breasts and the extensive necrosis and ulceration seen all over the body. Only three cases of SPTCL of the breast are reported in the literature 6 …”

“…Only three cases of SPTCL of the breast are reported in the literature. 6 Extra-cutaneous involvement is extremely rare, and approximately 20% of patients with SPTCL have an associated autoimmune disease. 1,7 The incidence of SPTCL in patients with systemic lupus erythematous is higher than in the general population.…”

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

“…Clinically and histopathologically, SPTCL can be difficult to distinguish from benign LEP. In addition, patients with cutaneous lymphomas may partially respond to steroid treatment, leading to a delayed actual diagnosis [ 1 , 14 , 15 ]. LEP is observed in 1–3% of patients with discoid lupus erythematous or systemic lupus erythematous [ 16 ].…”