Track: Case Reports

Abstract:

Cutaneous T-cell lymphomas (CTCLs) encompass a rare group of non-Hodgkin lymphomas with a broad clinical spectrum. This poses significant diagnostic challenges due to their variable morphology and clinical behavior. Woringer-Kolopp disease (localized pagetoid reticulosis) is a rare variant of CTCL that is particularly challenging to diagnose due to its indolent course, rarity, and its ability to mimic other common skin conditions. Differentiating rare subsets of CTCL requires histologic examination followed by prompt clinicopathologic correlation. This case series discusses two patients diagnosed with rare variants of CTCL through histologic means. The first case is a 66-year-old woman who presented with a pruritic, solitary 1 cm pink papule on the left elbow for several months. Biopsy revealed a cutaneous T-cell lymphoproliferative disorder, with clinical correlation suggesting Woringer-Kolopp disease. She had mild improvement with topical clobetasol but discontinued therapy due to worsening glycemic control related to her diabetes. The second case is a 58-year-old woman with a several-year history of CTCL previously cleared via phototherapy, who presented with scattered 1-4 mm hypopigmented to dark brown macules and papules predominantly on sun-exposed areas. Biopsy confirmed a CD8-positive T-cell infiltrate with epidermotropism, consistent with T-cell lymphoma. The patient was transitioned to topical bexarotene 1% gel. These cases highlight the broad clinical and histopathologic spectrum of rare CTCL subtypes and the importance of histologic work-up to guide diagnosis and management. Recognition of atypical morphologies and early biopsy are key to avoiding delayed diagnosis and optimizing care in these rare disorders.

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Bryan Ebert