Case 119 – Update 1

We are assisting the dermatology team in their investigation of a 68 year old man, with a longstanding history of eczema, presenting with erythematous, well defined patches and plaques over his trunk and limbs, a 2cm firm lesion on his right arm and right axillary lymphadenopathy.

Many thanks for everyone’s input thus far. Summary of requested investigations:

  • Bloods look unremarkable except for non-specific increase in inflammatory markers
  • Viral serology, including HIV and Human T-cell lymphotropic virus type 1, is negative
  • Skin biopsy reported as demonstrating an epidermotropic infiltrate of T cells (CD3+ CD4+ CD30+)
  • Peripheral blood flow cytometry does not indicate an excess of Sezary cells and there is no evidence of a clonal TCR gene rearrangement
  • Lymph node biopsy demonstrates reactive changes
  • PET-CT confirms a right axillary lymph node measuring 2.7 cm with moderate FDG avidity (SUV max, 3.9). Increased uptake at the right arm corresponding with the clinical lesion.

As you have stated, investigation findings are suggestive of cutaneous T cell lymphoma (CTCL), specifically mycosis fungoides (MF).

How would you go about staging and risk stratifying the disease? What treatment options would you consider at this point, and under which medical team?

 

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