Track

Case Reports

Abstract

Cutaneous T-cell lymphomas can present with diverse skin findings, often mimicking benign dermatoses or inflammatory conditions. Herein we report a case of T-cell lymphoma with a cytotoxic immunophenotype initially suspected to represent a soft tissue mass or vasculitis. A male truck driver in his 60s presented with worsening right leg pain, swelling, and multiple pink papulonodules on the right inner thigh. Two months prior, he noted pain in his right leg, initially attributed to an injury before being diagnosed with a deep vein thrombosis (DVT). Initial CT revealed an intramuscular mass within the adductor compartment with perivascular soft tissue infiltration around femoral vessels and possible femoral vein thrombus. However, MRI did not demonstrate a discrete mass, but subfascial inflammation and edema. CBC was unremarkable. Dermatology evaluation noted non-tender papulonodules and marked unilateral edema. A biopsy revealed a hypercellular mixed infiltrate extending from the dermis to subcutis with frequent mitotic figures, areas of necrosis, and a high Ki67 proliferative index. Lesional cells were positive for CD2, CD3, CD7, TIA-1, and granzyme B, while negative for CD4, CD8, CD5, CD20, CD34, CD56, CD30, TdT, and EBER. Additional stains for infectious organisms were negative. Concurrent bone marrow biopsy was negative. These findings were consistent with a T-cell lymphoma with a cytotoxic immunophenotype. This case highlights the diagnostic challenge of cutaneous T-cell lymphoma presenting with a nodular rash in the context of recent DVT. Imaging and targeted biopsy were essential for diagnosis, emphasizing the need to consider lymphoma in atypical post-thrombotic or inflammatory presentations.