A 71 years old female with extensive diffuse xeorsis with multiple poorly demarcated brown/hyperpigmented patches and lymphadenopath. Previously diagnosed as MF stage IV

    CLINICAL HISTORY:

    The patient is a 71-year-old female with a past medical history of hypertension, hypercholesterolemia and rheumatoid arthritis. She presented at the University of Miami Hospital with outside Hem/Onc records indicating a history of mycosis fungoides stage IV due to lymph node involvement in the axilla and groin. The patient originally presented with severe itching and the appearance of a full-body rash.

    Currently she has extensive diffuse xeorsis, probably 25% BSA, with multiple poorly demarcated brown/hyperpigmented patches. Palpable axillary and groin lymph nodes are also noted.

    Subsequent work-up revealed serology for HTLV-1 antibody was reactive.

    MICROSCOPIC Description:

    Biopsies of the patients’ right arm and left leg showed a lichenoid atypical lymphocytic infiltrates with infrequent Pautrier’s microabscesses and subtle epidermotropism.  Large cells were not readily seen. Immunophenotyping revealed that the tumor cells were CD3 + and CD5 + T cells with an increased ratio of CD4+ and CD8+ cells in both epidermis and dermis. The lymphoma cells express CD25 (about 95% of tumor cells). Near total loss of CD7 expression is noted. CD30+ large cells are rare (<1%) in both biopsies. PD1+ cells are not frequent (1% and 10%, respectively) in both biopsies.

    In the context of clinical history and HTLV-1 antibody detected by ELISA and Western blot, findings were best regarded as a CUTANEUS INVOLVEMENT OF ADULT T-CELL LEUKEMIA/ LYMPHOMA.