Abstract

Lymphoproliferative disorders that demonstrate angiocentricity and/or angioinvasion on histopathology classically are thought to include type E lymphomatoid papulosis (LyP), extranodal NK/T-cell lymphoma, nasal type, primary cutaneous gamma/delta T-cell lymphoma, and lymphomatoid granulomatosis. However, we have encountered patients with mycosis fungoides (MF) with angiocentricity and angioinvasion, and herein report three of these patients. Case One: A 73-year-old man presented with nonhealing lower extremity ulcers. Initial biopsies demonstrated an epidermotropic T-cell lymphoma that was CD4+/faintly CD56+/GM3-/EBER-. One of the biopsies showed notable angiocentricity and destruction, including fibrin deposition in the vessel walls. The diagnosis of angiocentric/angiodestructive MF was rendered. Case Two: Another 73-year-old man presented with indurated annular erythematous plaques of the bilateral arms and legs. Multiple biopsies were performed, some of which demonstrated a CD30+/CD56-/GM3-/EBER- T-cell lymphoma with angioinvasion and angiodestruction, most consistent with angioinvasive/angiodestructive MF. Case Three: A 63-year-old woman presented with ulcerated lesions of her fingers and wrist. Biopsies revealed a dense and diffuse infiltrate of CD3+/CD30-/CD56-/GM3-/EBER- large atypical lymphocytes, with angioinvasion and fibrin deposition noted along a vessel, leading to the diagnosis of angiocentric MF. Our experience, as well as a few similar cases reported in the literature, lead us to conclude that MF should not be excluded entirely from the differential diagnosis when evaluating angioinvasive/angiodestructive lymphoproliferative disorders. Additionally, two of these cases demonstrated abundant eosinophils admixed with the lymphocytes, which may be incidental or might signal an interesting phenotypic aspect of angioinvasive/angiodestructive MF.