Clinical case of complex diagnosis of skin T-cell lymphoma. Part 1

Malignant lymphomas of the skin combine a group of tumor diseases that are accompanied by monoclonal proliferation of lymphoid tissue in skin cells. The problem of lymphomas is relevant, as there is a high incidence of the disease (0.3 cases per 10 thousand of the population), as well as the complexity of early diagnosis and specific treatment. Incidence  T – cellular lymphoma among all malignant lymphomas is about 65%. Read the probable causes and clinical course of T-cell lymphomas at estet-portal.com. , as well as on a clinical example, learn about all the difficulties of diagnosing T – cellular lymphoma.

Causes and clinical manifestations of T – cellular lymphoma

Exact reason T – cellular lymphoma is unclear. There are opinions that provokes the appearance of T – cellular lymphoma Epstein virus – Barr, and also takes part in the development of the herpes virus type 1 process.

The most common type of primary skin lymphoma – mycosis fungoides, which manifests itself in the classical form of Aliber – Bazin.

It is accompanied by T proliferation – lymphocytes of medium and small size with the presence of cerebriform nuclei. Characteristic is the gradual evolution of spots into papules and nodes. Under what mask can lymphoma appear, read on estet-portal.com. Among all T – mycosis fungoides accounts for about 44% of cellular lymphomas.  The clinical course is accompanied by a gradual change of three stages – erythematous – squamous, infiltrative – plaque and tumor.

Diagnostics T – cellular lymphomas is very difficult, since the clinical course of the process can mimic a wide variety of dermatological conditions, and very often the establishment of a final accurate diagnosis takes several years.

Clinical case of complex diagnosis T – cellular lymphoma

Let's give an example of a clinical case T – cellular lymphoma, which proved difficult to diagnose.

Patient K., 75 years old, was admitted to the clinic for skin and venereal diseases in February 2014 with complaints of rashes that were localized all over her body and were accompanied by severe itching.

History of a patient with undiagnosed T – cellular lymphoma:

• The first spotted rashes appeared 3 years ago, without any – or causes, were located on the skin of the cheeks and were accompanied by itching. During this time, the patient went to different institutions, where various diagnoses were made.
• In the summer of 2012, the patient was treated at the clinic with a diagnosis of discoid lupus erythematosus. There was no effect after treatment.
• In the winter of 2013, the rash spread to the skin of the chest, after which the patient was re-hospitalized. The clinic ruled out the diagnosis of sarcoidosis. Morphological examination of the skin showed focal acanthosis and hyperkeratosis. In the superficial layers of the dermis, the vessels and small capillaries were dilated, and stromal edema was noted. Conducting additional research made it possible to discover LE – cells.

What was the treatment of unidentified T – cellular lymphoma?

In the hospital, she was treated with prospidin, topical steroids, antihistamines, and dexamethasone. The patient was discharged with blanching lesions and decreased itching. A few months later, the patient's chronic odontogenic sinusitis worsened, in connection with which a radical sinusotomy was performed.

After the procedure, a course of antibiotic therapy with lincomycin was carried out, which provoked an increase in symptoms – the rashes spread even more and the itching became intense again.

Sick  was re-admitted to the hospital.  What studies were conducted in the dermatological clinic, and which diagnosis was established instead of T  cellular lymphoma, read our next article.