Cutaneous T-cell lymphoma occurring with a melanocytic proliferation, masquerading as a nonhealing ulcer with reactive changes

William A. Kanner, Kevin White, Catherine I. Barry, Abigail J. Lee, John B. Cousar, Mark R. Wick, James W. Patterson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Two of the most challenging areas in dermatopathology are lymphoproliferative disorders and melanocytic lesions. We present a case of peripheral T-cell lymphoma occurring with an intradermal melanocytic proliferation. A 63-year-old Caucasian man presented with a 12-cm edematous, erythematous to violaceous, scalp ulceration that had enlarged over six months. Previous biopsies showed reactive changes which were concerning for infection. The last biopsies showed small to intermediate sized, angulated cells with clear cytoplasm within the dermis, with extension into the epidermis. These cells stained positive with markers for CD3, CD45RO and CD43, yet showed decreased expression of pan-T-cell markers CD5 and CD7, and absent expression of CD4, CD8, CD56 and CD57 and EBV. Molecular studies showed a clonal T-cell receptor gamma chain gene rearrangement. The diagnosis was peripheral T-cell lymphoma, unspecified. Another biopsy from an indurated area separate from the ulcer showed scattered, enlarged cells embedded in the same lymphocytic infiltrate. No mitotic figures were identified. These cells stained for S100 and Melan-A, in a partly nested arrangement. This was felt to represent a melanocytic nevus. This case likely represents an extraordinary coincidence of two distinctly different neoplasms.

Original languageEnglish (US)
Pages (from-to)67-72
Number of pages6
JournalJournal of Cutaneous Pathology
Volume38
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Cutaneous T-Cell Lymphoma
Ulcer
Peripheral T-Cell Lymphoma
Biopsy
gamma-Chain T-Cell Antigen Receptor Gene Rearrangement
T-Cell Receptor gamma Genes
MART-1 Antigen
Pigmented Nevus
Lymphoproliferative Disorders
Dermis
Scalp
Human Herpesvirus 4
Epidermis
Cytoplasm
T-Lymphocytes
Infection
Neoplasms

ASJC Scopus subject areas

  • Dermatology
  • Pathology and Forensic Medicine
  • Histology

Cite this

Cutaneous T-cell lymphoma occurring with a melanocytic proliferation, masquerading as a nonhealing ulcer with reactive changes. / Kanner, William A.; White, Kevin; Barry, Catherine I.; Lee, Abigail J.; Cousar, John B.; Wick, Mark R.; Patterson, James W.

In: Journal of Cutaneous Pathology, Vol. 38, No. 1, 01.2011, p. 67-72.

Research output: Contribution to journalArticle

Kanner, William A. ; White, Kevin ; Barry, Catherine I. ; Lee, Abigail J. ; Cousar, John B. ; Wick, Mark R. ; Patterson, James W. / Cutaneous T-cell lymphoma occurring with a melanocytic proliferation, masquerading as a nonhealing ulcer with reactive changes. In: Journal of Cutaneous Pathology. 2011 ; Vol. 38, No. 1. pp. 67-72.
@article{252f2c6acb2f47b2b76ce88882759941,
title = "Cutaneous T-cell lymphoma occurring with a melanocytic proliferation, masquerading as a nonhealing ulcer with reactive changes",
abstract = "Two of the most challenging areas in dermatopathology are lymphoproliferative disorders and melanocytic lesions. We present a case of peripheral T-cell lymphoma occurring with an intradermal melanocytic proliferation. A 63-year-old Caucasian man presented with a 12-cm edematous, erythematous to violaceous, scalp ulceration that had enlarged over six months. Previous biopsies showed reactive changes which were concerning for infection. The last biopsies showed small to intermediate sized, angulated cells with clear cytoplasm within the dermis, with extension into the epidermis. These cells stained positive with markers for CD3, CD45RO and CD43, yet showed decreased expression of pan-T-cell markers CD5 and CD7, and absent expression of CD4, CD8, CD56 and CD57 and EBV. Molecular studies showed a clonal T-cell receptor gamma chain gene rearrangement. The diagnosis was peripheral T-cell lymphoma, unspecified. Another biopsy from an indurated area separate from the ulcer showed scattered, enlarged cells embedded in the same lymphocytic infiltrate. No mitotic figures were identified. These cells stained for S100 and Melan-A, in a partly nested arrangement. This was felt to represent a melanocytic nevus. This case likely represents an extraordinary coincidence of two distinctly different neoplasms.",
author = "Kanner, {William A.} and Kevin White and Barry, {Catherine I.} and Lee, {Abigail J.} and Cousar, {John B.} and Wick, {Mark R.} and Patterson, {James W.}",
year = "2011",
month = "1",
doi = "10.1111/j.1600-0560.2009.01485.x",
language = "English (US)",
volume = "38",
pages = "67--72",
journal = "Journal of Cutaneous Pathology",
issn = "0303-6987",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Cutaneous T-cell lymphoma occurring with a melanocytic proliferation, masquerading as a nonhealing ulcer with reactive changes

AU - Kanner, William A.

AU - White, Kevin

AU - Barry, Catherine I.

AU - Lee, Abigail J.

AU - Cousar, John B.

AU - Wick, Mark R.

AU - Patterson, James W.

PY - 2011/1

Y1 - 2011/1

N2 - Two of the most challenging areas in dermatopathology are lymphoproliferative disorders and melanocytic lesions. We present a case of peripheral T-cell lymphoma occurring with an intradermal melanocytic proliferation. A 63-year-old Caucasian man presented with a 12-cm edematous, erythematous to violaceous, scalp ulceration that had enlarged over six months. Previous biopsies showed reactive changes which were concerning for infection. The last biopsies showed small to intermediate sized, angulated cells with clear cytoplasm within the dermis, with extension into the epidermis. These cells stained positive with markers for CD3, CD45RO and CD43, yet showed decreased expression of pan-T-cell markers CD5 and CD7, and absent expression of CD4, CD8, CD56 and CD57 and EBV. Molecular studies showed a clonal T-cell receptor gamma chain gene rearrangement. The diagnosis was peripheral T-cell lymphoma, unspecified. Another biopsy from an indurated area separate from the ulcer showed scattered, enlarged cells embedded in the same lymphocytic infiltrate. No mitotic figures were identified. These cells stained for S100 and Melan-A, in a partly nested arrangement. This was felt to represent a melanocytic nevus. This case likely represents an extraordinary coincidence of two distinctly different neoplasms.

AB - Two of the most challenging areas in dermatopathology are lymphoproliferative disorders and melanocytic lesions. We present a case of peripheral T-cell lymphoma occurring with an intradermal melanocytic proliferation. A 63-year-old Caucasian man presented with a 12-cm edematous, erythematous to violaceous, scalp ulceration that had enlarged over six months. Previous biopsies showed reactive changes which were concerning for infection. The last biopsies showed small to intermediate sized, angulated cells with clear cytoplasm within the dermis, with extension into the epidermis. These cells stained positive with markers for CD3, CD45RO and CD43, yet showed decreased expression of pan-T-cell markers CD5 and CD7, and absent expression of CD4, CD8, CD56 and CD57 and EBV. Molecular studies showed a clonal T-cell receptor gamma chain gene rearrangement. The diagnosis was peripheral T-cell lymphoma, unspecified. Another biopsy from an indurated area separate from the ulcer showed scattered, enlarged cells embedded in the same lymphocytic infiltrate. No mitotic figures were identified. These cells stained for S100 and Melan-A, in a partly nested arrangement. This was felt to represent a melanocytic nevus. This case likely represents an extraordinary coincidence of two distinctly different neoplasms.

UR - http://www.scopus.com/inward/record.url?scp=78649665041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649665041&partnerID=8YFLogxK

U2 - 10.1111/j.1600-0560.2009.01485.x

DO - 10.1111/j.1600-0560.2009.01485.x

M3 - Article

VL - 38

SP - 67

EP - 72

JO - Journal of Cutaneous Pathology

JF - Journal of Cutaneous Pathology

SN - 0303-6987

IS - 1

ER -