![]() ![]() ![]() Moreover, the host responses between patients may differ, which may contribute to the various presentations (1). Various clinical morphologies may be elicited by lymphocytes with the differing phenotypes. A review indicated that cases with unusual cell populations, such as the present case, often have unique clinical presentations (7). The neoplastic T cells present in MF are typically CD4 + and CD8 – however, there are variants in which 1 or both of these subpopulations are lost. Summary of reported cases of mycosis fungoides producing eruptions resembling erythema gyratum repens The present case is the first associated with an underlying malignancy. To our knowledge, only 6 cases, including the present case, of MF resembling EGR, have been reported (2–6) (Table I). The rash consists of serpiginous, erythematous, concentric bands that can be figurate, gyrate, or annular, and are arranged in parallel rings lined by a fine, trailing edge of scale a pattern often described as “wood grained.” EGR is a rare paraneoplastic syndrome strongly associated with various malignancies, particularly lung, breast, and oesophageal cancers. EGR-like MF, has recently been described as a possible rare form of MF. Patients usually present with patches, plaques, tumours, and/or erythroderma. MF is characterized by extremely variable presentation, and reportedly mimicks at least 25 dermatoses (1). No major changes in the skin lesions were noted following surgical excision of the lung cancer. (H&E-stain: (a) × 100 (b) CD3 (c) CD4 and (d) CD8 × 200).Ī diagnosis of Stage IB (T2N0M0B0) MF was confirmed, and treatment with cycles of photochemotherapy (psoralen plus ultraviolet A radiation PUVA) combined with topical corticosteroids was initiated, achieving partial clinical remission. (b–d) Immunohistochemical features: the intraepidermal lymphocytes are CD3 + (b), CD4 – (c) and CD8 – (d). (a) Histology revealed a dense infiltrate containing small lymphocytes with epidermotropism of atypical lymphocytes. Clinical evaluation did not show spreading of TCL, but indicated primary lung adenocarcinoma.įig. Molecular biology investigations indicated a monoclonal rearrangement of the T-cell receptor (TCR)-beta chain. Immunohistochemical studies showed that most cells within the epidermis and dermis were CD3 +, CD4 –, CD8 – and CD45RO + (Fig. Cutaneous histopathology revealed a dense infiltrate of hyperchromatic, atypical lymphocytes that showed extensive epidermotropism. Type 1 human T-lymphotropic virus infection was also excluded. Microscopy and culture excluded the presence of a mycotic infection. Dermatological examination revealed concentric, slightly infiltrated, annular, red patches and plaques, closely resembling EGR, on his chest, abdomen and extremities (Fig. We describe here a case of MF, presenting as erythema gyratum repens (EGR)-like lesions, in a patient with lung cancer.Ī 73-year-old Japanese man presented with a 10-year history of worsening, itchy, erythematous eruptions on his trunk and extremities. Mycosis fungoides (MF), a common type of cutaneous T-cell lymphoma (TCL), can mimic various dermatoses.
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