Abstract:

Primary cutaneous lymphomas are the second most common group of extranodal lymphomas, of which cutaneous T-cell lymphomas represent approximately 70%. However, a subset of CD8+ T cell lymphomas are rare and pose significant diagnostic challenges. We report a case of a 69-year-old man with a history of diffuse large B-cell lymphoma who presented with a 2-week onset of a rapidly growing solitary plaque on his cheek which was unresponsive to intralesional triamcinolone and doxycycline therapy. The biopsy demonstrated an infiltrate of medium-sized CD8+ T lymphocytes with a cytotoxic phenotype, focal epidermotropism, and an elevated proliferative index with Ki-67. CD30 was negative. The histologic differential diagnosis included a primary cutaneous acral CD8+ T-cell lymphoma, which is known to have an excellent prognosis, and primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma. Although the patient presented with an isolated erythematous papule on his cheek, it progressed to a large erythematous and ecchymotic plaque, and he developed multiple nodules on the forehead and torso. A subsequent biopsy from the back demonstrated similar findings of CD8+ T cell lymphoma. Overall, given the elevated Ki-67 and a clinical progression with multiple lesions, the diagnosis of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma was made. This case highlights the challenges and the multifaceted approach in the diagnostic work-up of a cutaneous CD8+ lymphoproliferative disorder.

Financial Disclosure:
No current or relevant financial relationships exist.

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Eduardo Rodriguez, MD