Abstract:

Background: Mycosis fungoides (MF) is the most prevalent cutaneous T-cell lymphoma and can present with a spectrum of clinical findings. Case: We describe a case of multiple, asymptomatic verrucous lesions on the extremities in a 37-year-old African American female. She presented with multiple 2 cm - 4 cm hyperpigmented verrucous plaques on the abdomen and thighs. She also had a mildly enlarged posterior cervical lymph node and an enlarged left axillary lymph node. Punch biopsy from the thigh showed hyperkeratosis, mild epidermal acanthosis, and papillomatosis, with a dense lymphocytic infiltrate within the papillary and upper reticular dermis. The lymphocytes demonstrated nuclear hyperchromasia and nuclear contour irregularities. They involved the overlying epidermis both singly and as clusters of cells with minimal associated spongiosis. No evidence of large cell transformation was noted. Immunohistochemistry revealed that lesional cells expressed CD45, CD3, CD5, CD43, and CD4. They partially expressed CD2, but were negative for CD8, TDT, CD56, CD20, CD7, CD34, TIA1, and EBV. CD30 expression was observed in approximately 35% of the cells. A monoclonal T-cell receptor-gamma chain gene rearrangement was detected. The patient underwent a PET scan which revealed FDG uptake in the neck, supraclavicular/subpectoral region, axilla, and pelvis. She was diagnosed with verrucous mycosis fungoides (MF). Conclusion: Verrucous MF is a rare manifestation of MF which clinically presents as hyperkeratotic and verrucous plaques that cover the acral surfaces, in addition to the lower legs, trunk, and face. The verrucous presentation may mimic benign inflammatory conditions and risk delay in the diagnosis of MF.

Financial Disclosure:
No current or relevant financial relationships exist.

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Sandra Oska, MD