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Gleason L, Joffe D, Bhatti S, Cohen A, Banner L, Correia E, Alpdogan O, Porcu P, Nikbakht N. Recalcitrant Subcutaneous Panniculitis-Like T-Cell Lymphoma Responsive to Histone Deacetylase Inhibitor. Case Rep Oncol 2022; 15:1088-1094. [PMID: 36605220 PMCID: PMC9808134 DOI: 10.1159/000526641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 12/14/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous T-cell lymphoma that usually presents with tender subcutaneous nodules on the trunk and extremities. Immunosuppressive therapy is considered first-line treatment for SPTCL, while multiagent chemotherapy is used for SPTCL complicated by hemophagocytic lymphohistiocytosis (HLH). Here, we report a 42-year-old Hispanic man that presented with a 5-year history of recurrent painful subcutaneous lesions in the absence of constitutional symptoms, lymphadenopathy, and hepatosplenomegaly. A punch biopsy revealed an atypical lymphoid infiltrate in between subcutaneous adipose lobules. Lymphocytes expressed CD3, CD8, and Beta F-1 and did not express CD4 and CD56. Based on clinical and histologic findings, the patient was diagnosed with SPTCL. In addition, laboratory findings did not demonstrate any evidence of HLH. He was initially started on both prednisone and hydroxychloroquine with no improvement. A trial of cyclosporine and methotrexate yielded no clinical improvement. As the lesions failed to resolve after treatment with multiple immunosuppressive agents, romidepsin, an intravenous histone deacetylase (HDAC) inhibitor, was initiated. After two cycles of romidepsin, the patient achieved complete clinical response. He continues to be in remission 12 months later with monthly maintenance therapy. This case illustrates that romidepsin can be useful as monotherapy for refractory SPTCL without HLH.
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Affiliation(s)
- Laura Gleason
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Joffe
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Safiyyah Bhatti
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA,Division of Hematologic Malignancies and HSCT, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexa Cohen
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lauren Banner
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily Correia
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Onder Alpdogan
- Division of Hematologic Malignancies and HSCT, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and HSCT, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
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He S, Wang N, Feng J, He X, Wang Y, Chen L. A case report and literature review: subcutaneous panniculitis-like T-cell lymphoma with liver failure as the main manifestation. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1408. [PMID: 36660620 PMCID: PMC9843430 DOI: 10.21037/atm-22-5284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Background Subcutaneous lipofuscinosis-like T-cell lymphoma (SPTCL) is a rare cutaneous lymphoma that often presents as recurrent subcutaneous nodules and may progress to hemophagocytic syndrome with fever and hepatic impairment in some patients. However, no cases of progression to hepatic failure have been reported. Here, we present a case of an adult diagnosed with fever and liver failure as the main manifestation, which was eventually confirmed as SPTCL by skin biopsy, but the patient eventually died due to disease progression. Case Description This study retrospectively reports a rare case of SPTCL in a 34-year-old female patient who was admitted with scleral jaundice for 1 month and fever for 20 days. Examination revealed multiple small subcutaneous nodules on the skin of the chest and tibial surface and an enlarged liver and spleen. Laboratory tests revealed hepatic impairment, and common causes of liver failure (viral infection, fatty liver, immune liver damage, etc.) were excluded. We continued to refine the positron emission tomography-computed tomography (PET-CT) examination, which revealed multiple flocculent and nodular hyperdense shadows with increased metabolism in the subcutaneous fat interstices. And then, we performed a skin biopsy and the final pathological diagnosis was SPTCL, but the patient died 1 month after diagnosis due to poor treatment outcome because the disease progressed too rapidly. With this case report, we hope to improve clinicians' understanding of liver injury caused by SPTCL. A review of the literature revealed that this is the first case report in the literature of SPTCL leading to severe liver failure. Conclusions For patients presenting with fever and liver injury, primary liver disease cannot simply be assumed, as this presentation may be a manifestation of some extra-hepatic diseases, including SPTCL. For this condition, early detection and early diagnosis may improve the prognosis of patients.
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Affiliation(s)
- Sike He
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Neng Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaming Feng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Liyu Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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Nourbakhsh SMK, Bahadoram M, Kosari F, Jafari M, Aslani N, Hassanzadeh S. Subcutaneous panniculitis-like T-cell lymphoma in a young girl presenting with periorbital edema and fever: A case report. Clin Case Rep 2022; 10:e05462. [PMID: 35198209 PMCID: PMC8841027 DOI: 10.1002/ccr3.5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/08/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma is a rare and highly malignant extra-nodal lymphoma. It has a wide range of clinical presentations (such as periorbital swelling as in our case) and should be considered in the differential diagnosis of systemic lupus erythematosus, especially in children.
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Affiliation(s)
- Seyed Mohamad Kazem Nourbakhsh
- Department of Pediatric Hematology and OncologyImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mohammad Bahadoram
- Thalassemia and Hemoglobinopathy Research CenterHealth Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Farid Kosari
- Department of PathologySchool of Medicine Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Mehrdad Jafari
- Department of OtorhinolaryngologyImam Khomeini hospital complexTehran University of Medical SciencesTehranIran
| | - Nahid Aslani
- Department of PediatricsTehran University of Medical ScienceTehranIran
| | - Shakiba Hassanzadeh
- Thalassemia and Hemoglobinopathy Research CenterHealth Research InstituteAhvaz Jundishapur University of Medical SciencesAhvazIran
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Abstract
Primary cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. CTCL subtypes demonstrate a variety of clinical, histological, and molecular features, and can follow an indolent or a very aggressive course. The underlying pathogenetic mechanisms are not yet entirely understood. The pathophysiology of CTCL is complex and a single initiating factor has not yet been identified. Diagnosis is based on clinicopathological correlation and requires an interdisciplinary team. Treatment decision is made based on short-term and long-term goals. Therapy options comprise skin-directed therapies, such as topical steroids or phototherapy, and systemic therapies, such as monoclonal antibodies or chemotherapy. So far, the only curative treatment approach is allogeneic haematopoietic stem cell transplantation. Novel therapies, such as chimeric antigen receptor T cells, monoclonal antibodies or small molecules, are being investigated in clinical trials. Patients with CTCL have reduced quality of life and a lack of effective treatment options. Further research is needed to better identify the underlying mechanisms of CTCL development and course as well as to better tailor treatment strategies to individual patients.
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Li L, Wu C, Chai Y, Dong C, Zhao L. Chidamide induces long-term remission in rare subcutaneous panniculitis-like T-cell lymphoma: An unusual case report and literature review. Int J Immunopathol Pharmacol 2021; 35:20587384211009342. [PMID: 33845613 PMCID: PMC8059039 DOI: 10.1177/20587384211009342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma composed of CD8+ cytotoxic T-cell that is primarily localized in the subcutaneous tissue. No standard treatments are currently available for SPTCL due to its rarity. Chemotherapy, radiotherapy, immunosuppressive agents, and hematopoietic stem cell transplantation (HSCT) have been used frequently, however, the effects of these treatment approaches remain controversial. In this report, we present an unusual case of SPTCL in a 47-year-old woman whose initial symptoms were atypical. The patient was started on etoposide, vincristine, cyclophosphamide, doxorubicin, and prednisone (EPOCH) chemotherapy once diagnosed. After two cycles of chemotherapy, her clinical symptoms were not significantly improved. Subsequently, histone deacetylase (HDAC) inhibitor chidamide was added to the chemotherapy from the third cycle. She recovered gradually and achieved complete remission (CR) after four cycles of chemotherapy combined with chidamide, followed by chidamide monotherapy for maintenance. More than 1 year after the therapy, she remained in CR. Our case illustrates, for the first time, chidamide can be an effective agent to induce long-term remission for rare SPTCL.
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Affiliation(s)
- Liangliang Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Chongyang Wu
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ye Chai
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Chi Dong
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
| | - Li Zhao
- Department of Central Laboratory, The First Hospital of Lanzhou University, Lanzhou, China
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Pukhalskaya T, Brown JA, Sills AA, Smoller BR. A Longstanding, Persistent and Recurrent Case of Cryptogenic Panniculitis. Case Rep Dermatol 2020; 12:199-208. [PMID: 33362504 PMCID: PMC7747046 DOI: 10.1159/000509605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous T-cell lymphoma. There may be a significant histologic overlap with traumatic panniculitis and lupus profundus. We describe a 54-year-old woman who had received a diagnosis of SPTCL based upon a left parietal scalp biopsy 5 years earlier. This diagnosis was supported by immunohistochemistry (IHC) demonstrating a CD8+ predominant lymphocyte population in the subcutis. T-cell gene rearrangement studies were not performed at that time. The patient was treated and showed significant clinical improvement. When several tender erythematous subcutaneous nodules appeared on the upper back, left plantar surface and pretibial region, repeat biopsy was performed. Histology revealed a lobular and septal panniculitis with no vasculitis. The infiltrate contained abundant eosinophils and histiocytes not seen in the original biopsy specimen. IHC demonstrated a mixture of CD4+, CD8+ and CD7+ lymphocytes with abundant CD68+ histiocytes. T-cell gene rearrangement studies performed on one of the lesions failed to demonstrate clonality. It is important to recognize that patients with SPTCL are not exempt from other types of panniculitis, and complete histologic, IHC and molecular workups are essential to properly classify all cutaneous lesions in these patients.
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Affiliation(s)
- Tatsiana Pukhalskaya
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - J Ahmad Brown
- Arkansas Dermatopathology, Little Rock, Arkansas, USA
| | | | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Gochhait D, Kekade S, Devi D, Srinivas BH, Siddaraju N, Chandrashekar L. Subcutaneous Panniculitis-Like T Cell Lymphoma: Approach to Differential Diagnosis on Cytology. J Adolesc Young Adult Oncol 2019; 9:120-123. [PMID: 31580741 DOI: 10.1089/jayao.2019.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sighting a case of subcutaneous panniculitis-like T cell lymphoma (SPTCL) in cytology is very rare in a clinical scenario. Among the differential diagnoses (D/D) of a subcutaneous nodule undergoing fine needle aspiration cytology (FNAC), it is hardly considered in the list. The common D/D on cytology would be panniculitis or a non-SPTCL lymphoma. To make a correct cytological diagnosis, the pathologist has to meticulously observe the type of inflammatory infiltrate, their morphology, the intimate admixture of the fat lobules, and background necrosis or macrophages. This article describes the cytological picture, D/D, and the prognostic factors associated with SPTCL in a young male. He was suspected of SPTCL after FNAC and later confirmed on histopathology with specific immunomarkers. We do not recommend the confirmation of SPTCL on cytology however, we would like to stress that it can be picked up and differentiated from its mimickers on FNAC.
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Affiliation(s)
- Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shailesh Kekade
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Durga Devi
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Laggis C, Miles R, Stephens DM, Duffy K, Bowen A, Wada D. Cutaneous mantle cell lymphoma histomorphologically mimicking subcutaneous panniculitis‐like T‐cell lymphoma: Case report. J Cutan Pathol 2019; 46:538-541. [DOI: 10.1111/cup.13471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Caroline Laggis
- Department of DermatologyUniversity of Utah Salt Lake City Utah
| | - Rodney Miles
- Department of Pathology, Division of Clinical PathologyUniversity of Utah Salt Lake City Utah
| | - Deborah M. Stephens
- Division of Hematology and Hematologic Malignancies, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
| | - Keith Duffy
- Department of DermatologyUniversity of Utah Salt Lake City Utah
| | - Anneli Bowen
- Department of DermatologyUniversity of Utah Salt Lake City Utah
| | - David Wada
- Department of DermatologyUniversity of Utah Salt Lake City Utah
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Xavier AC, Suzuki R. Treatment and prognosis of mature (non-anaplastic) T- and NK-cell lymphomas in childhood, adolescents, and young adults. Br J Haematol 2019; 185:1086-1098. [PMID: 30706440 DOI: 10.1111/bjh.15772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paediatric non-Hodgkin lymphomas (pNHL) are a diverse group of malignancies characterised by nodal and/or extranodal involvement. Less common pNHL forms include those derived from mature T- and natural killer (NK) cells. Much of our current understanding of paediatric mature (non-anaplastic) T/NK-cell lymphomas with respect to pathogenesis, diagnosis and treatment is extrapolated from adult literature. At the Sixth International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma, convened September 26-29, 2018 in Rotterdam, The Netherlands, some important aspects on diagnosis and outcomes of mature (non-anaplastic) T/NK-cell lymphoma in children and adolescents were discussed and will be reviewed in here.
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Affiliation(s)
- Ana C Xavier
- Division of Hematology/Oncology, Department of Pediatrics, Children's of Alabama/University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ritsuro Suzuki
- Department of Haematology/Oncology, Shimane University Hospital, Izumo, Japan
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