Abstract

We present an 85-year-old male patient with a medical history significant for psoriasis who presented with a thigh wound that expanded slowly over the course of 9 months. Patient was previously treated for cellulitis. Physical examination showed open chronic wounds with purulent discharge with concern for osteomyelitis and debridement was performed. Histological examination of the tissue samples revealed a broad ulceration with large areas of necrosis extending into the subcutis. The edge of the specimen also revealed a nodular lymphoid infiltrate in the subcutaneous adipose tissue composed of large cells with irregular nuclei, open chromatin, prominent nucleoli, and scant to moderate cytoplasm. The neoplastic infiltrate was positive for CD3, CD4, and TCR delta stains. Ki-67 proliferation index of lymphoma cells was about 70%. The tumor cells were negative for CD30, CD8, CD56, TCR BF1, Granzyme, TIA1, CD123 and EBER ish stains. CD20 highlighted few scattered B-cells. A diagnosis of gamma-delta T-cell lymphoma was made. Further imaging showed multiple organ involvements. Patient was started on mini- CHOP and filgrastim, however, patient passed away within one month after the diagnosis. This is an interesting case of gamma-delta T-cell lymphoma that was diagnosed on a chronic wound. Additionally, it showed a CD4+, CD8- phenotype that is exceedingly rare for PCGDTCL, raising the possibility of gamma-delta mycosis fungoides. However, widespread disease, hepatosplenomegaly and cytopenias were favorable for PCGDTCL. Negative expression of cytotoxic markers was also unusual.