Track: Case Reports

Topic: Lymphoproliferative Disorders

Abstract:

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma. Apart from the classic patch/plaque, atypical forms of mycosis fungoides include follicular, hypopigmented, granulomatous, bullous, hyperpigmented, hyperkeratotic, and verrucous mycosis fungoides. Unilesional mycosis fungoides is a rare variant. It is characterized by a solitary lesion indistinguishable from that of mycosis fungoides clinically and histopathologically. Although pigmentary changes such as hypopigmentation or poikiloderma associated with mycosis fungoides has often reported, hyperpigmented mycosis fungoides is another rare variant of mycosis fungoides. In this case, we report a case of unilesional hyperpigmented mycosis fungoides treated with localized electron beam. A 30-year-old Korean woman presented with mildly pruritic, brown-colored, hyperpigmented macules on her left breast. She had no known other disorders, or drug intake. Skin biopsy from her breast revealed epidermotropism of atypical lymphocytes, basal vacuolization and apoptotic bodies in dermoepidermal junction.In addition, multiple large melanin granuleswithin melanophageswere present throughout the dermis. Lastly, the analysis for TCR gene rearrangement found monoclonal expansion of T cells. Laboratory examinations, including complete blood cell countsand peripheral blood cell morphologieswere within normal limits. We diagnosed the patient as having unilesional hyperpigmented mycosis fungoides. She received localized electron beam with a complete durable clinical response.

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Chong Won Choi, MD, PhD