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Cutaneous mantle cell lymphoma histomorphologically mimicking subcutaneous panniculitis-like T-cell lymphoma: Case

Caroline Laggis1, Rodney Miles2, Deborah M Stephens3

  • 1Department of Dermatology, University of Utah, Salt Lake City, Utah.

Journal of Cutaneous Pathology
|April 9, 2019
PubMed

Insights

Mantle cell lymphoma (MCL) rarely affects the subcutaneous fat, mimicking panniculitis. This case highlights MCL presenting with adipocyte rimming, emphasizing diagnostic challenges in cutaneous lymphoma.

Area of Science:

  • Oncology
  • Dermatopathology
  • Hematopathology

Background:

  • Mantle cell lymphoma (MCL) is an aggressive B-cell malignancy that uncommonly involves the skin.
  • Cutaneous MCL typically presents in the dermis; subcutaneous involvement with panniculitis-like features is rare.
  • Subcutaneous lymphocytic infiltrates can mimic inflammatory conditions or other lymphomas, like subcutaneous panniculitis-like T-cell lymphoma (SPTCL).

Observation:

  • A 69-year-old man with known systemic MCL developed subcutaneous nodules on his lower extremities post-chemotherapy.
  • Histopathology revealed atypical lymphoid cells infiltrating subcutaneous fat with characteristic adipocyte rimming.
  • Morphology was atypical for MCL and mimicked SPTCL.

Findings:

  • Immunohistochemistry confirmed the atypical cells as CD20+, CD5+ B-cells with strong cyclin D1 expression.
  • Fluorescence in situ hybridization (FISH) confirmed the t(11;14) translocation, characteristic of MCL.
  • Diagnosis of secondary cutaneous MCL with a panniculitis pattern was confirmed.

Implications:

  • This case demonstrates an exceptional presentation of cutaneous MCL mimicking panniculitis and SPTCL.
  • Highlights the importance of integrating clinical, histological, immunohistochemical, and molecular findings for accurate cutaneous lymphoma diagnosis.
  • Supports the need for comprehensive diagnostic workup in suspected cutaneous lymphoma cases.

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