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Case 135 - Discussion

Hematopathology Case

CD2 CD20
CD3 CD4
CD5 CD7
CD8 Ki67

Patient had a history of mycosis fungoides. The nodal architecture is mostly preserved with interfollicular expansion, which consists predominantly of CD4+ T-cells with aberrant CD7 loss. Clonal T-cell receptor gene rearrangement is also detected by PCR. Therefore, the overall findings support nodal infiltration by cutaneous T-cell lymphoma.

Cutaneous T-Cell Lymphoma Involving Lymph Node

The lymph node shows predominantly interfollicular expansion with mostly T-cell infiltration. The early stage of cutaneous T-cell lymphoma with lymph node involvement is almost identical to dermatopathic lymphadenopathy, and the distinction of these two entities can be very challenging. Helpful hints include:

  1. Clinical history of cutaneous T-cell lymphoma;

  2. More extensive nodal infiltration in lymphoma with more obvious architectural distortion;

  3. Presence of atypical lymphocytes, which are usually larger than reactive lymphocytes with irregular nuclei;

  4. Aberrant antigen gain or loss in T-cells: i.e. loss of CD7 or gain of CD30;

  5. Clonal TRG@ gene rearrangement.