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Cutaneous T-cell lymphoma: value of CT in staging and determining prognosis
L M Miketic1, T P Chambers, B C Lembersky
1Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA 15213.
Objective:
The usefulness of CT in diagnosing, staging, and establishing the prognosis in cutaneous T-cell lymphoma was assessed. CT abnormalities indicative of the disease, diffuse peripheral adenopathy and skin lesions, as well as less specific signs of generalized lymphoma, were correlated with clinical findings.
Materials And Methods:
The study group comprised 33 patients from a total of 87 with pathologically proved cutaneous T-cell lymphoma who were seen at the University of Pittsburgh Medical Center between 1986 and 1991 and who had CT scans. All patients had body CT imaging with contiguous axial sections no thicker than 10 mm of the chest, abdomen, and pelvis; other CT studies were performed as clinically indicated. Because of the cutaneous nature of this lymphoma, collimation included the skin surface.
Results:
In 10 of the 33 patients, all of whom had stage II or higher disease, abnormalities indicative of cutaneous T-cell lymphoma were seen on CT scans. All 10 had multiple areas of focal skin thickening or plaques several centimeters or more in diameter and 5 mm or greater in thickness affecting the dermal tissues while leaving the subcutaneous fat intact. Extension of individual lesions below the dermis was associated with the development of squamous cell cancers in two patients, both of whom had previous topical therapy. Seven of the 10 also had an unusual pattern of lymphadenopathy: the mediastinum or paraaortic regions were spared while enlarged peripheral nodes were seen in both the axillary and inguinal areas. Skin abnormalities were seen on CT scans of all patients with lymphadenopathy.
Conclusion:
CT findings in cutaneous T-cell lymphoma are related to the pathophysiology of the disease: cutaneous plaques and diffuse peripheral adenopathy that spare the mediastinal and paraaortic lymph nodes. Although the skin lesions can be easily evaluated clinically, secondary malignant neoplasms arising in treated skin lesions can be found with CT by their extension into the subcutaneous fat.