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Case 136 - Discussion

Hematopathology Case

 

 

CD20 CD3

CD4 CD5
CD2

CD8

Ki67 CD7
   

Patient had a history of mycosis fungoides. This case is very similar to case 135 except that there are more atypical cells in the interfollicular regions. 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.