[2 unusual cutaneous T-cell lymphomas with extracutaneous involvement]

Area of Science:

• Dermatology
• Hematology
• Oncology

Background:

• Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of malignant skin conditions.
• Early diagnosis and classification of CTCLs are crucial for effective treatment and prognosis.
• Unique presentations can pose diagnostic challenges, necessitating advanced investigative techniques.

Observation:

• Two patients presented with unusual skin manifestations, including edematous infiltration, papules, poikiloderma-like changes, and scarring.
• One patient exhibited marked leukocytosis and lymphadenopathy, suggesting systemic involvement.
• Skin lesions evolved over time, with one case progressing to papules and nodules.

Findings:

• Histological, immunohistological, and immunophenotypic analyses revealed unclassifiable CD8+, alpha, beta +, CD10+ cutaneous T-cell lymphoma with leukemic involvement in the first patient.
• The second patient was diagnosed with unclassifiable CTCL associated with a monoclonal proliferation of T-cell receptor V gamma 9, delta + large granular T lymphocytes.
• The second patient ultimately developed acute pre-T lymphoblastic leukemia.

Implications:

• These cases highlight the diverse and sometimes atypical presentations of cutaneous T-cell lymphomas.
• Advanced diagnostic methods are essential for classifying rare CTCL subtypes.
• Understanding these unique T-cell lymphomas can improve diagnostic accuracy and inform treatment strategies for challenging cases.