Bone marrow involvement by subcutaneous Panniculitis-like T-cell lymphoma: a report of three cases

Abstract

Subcutaneous panniculitis-like T-cell lymphoma is a rare subtype of cutaneous T-cell lymphoma. Virtually all cases are confined to the subcutaneous adipose tissue. In this report, we describe the first small series of subcutaneous panniculitis-like T-cell lymphoma (three patients) with bone marrow involvement. All patients presented with skin or soft tissue nodules, fever, and constitutional symptoms, and were diagnosed with subcutaneous panniculitis-like T-cell lymphoma based on the characteristic morphologic and immunophenotypic features of the subcutaneous lesions. Bone marrow core biopsies in these cases showed focal involvement by lymphoma with pathologic features similar to those seen in the diagnostic biopsies. Our observations suggest bone marrow involvement by subcutaneous panniculitis-like T-cell lymphoma does occur, and can be identified histologically and confirmed using standard immunohistochemistry. Our findings raise awareness of bone marrow involvement in this rare entity. However, the incidence and significance of bone marrow involvement in subcutaneous panniculitis-like T-cell lymphoma requires further evaluation.

A Case of Refractory Subcutaneous Panniculitis-like T-cell Lymphoma with Bone Marrow and Lung Involvement Treated Successfully with Oral Etoposide

“…Even in cases treated with combination chemotherapies, 4 cases were refractory to the firstline chemotherapies, experienced recurrence or died within 2 months after diagnosis (4)(5)(6)8). Prolonged etoposide monotherapy resulted in long-term remission in our case following a relapse episode after CHOP therapy, while 3 cases were previously reported to experience recurrence after combination chemotherapies including etoposide (5,6,8). Chronic daily oral low-dose etoposide therapy is re-portedly effective in refractory lymphoma (13).…”

Subcutaneous Panniculitis-Like T-Cell Lymphoma With Bone Marrow Involvement

“…Morphologic and immunophenotypic evidence of bone marrow involvement by SPTCL has only recently been described in three patients. 13 All patients had concurrent skin lesions meeting current diagnostic criteria for SPTCL. Bone marrow biopsy specimens showed focal involvement by cytologically atypical lymphocytes that expressed CD3 and CD8 and rimmed individual adipocytes.…”

“…3,5,6 Morphologic bone marrow involvement by the neoplastic cells of SPTCL has only recently been described in three patients. 13 Previously, bone marrow examination in patients with SPTCL has been significant only for hemophagocytosis. 3,8,9,12 Autopsies performed on five patients with SPTCL and fatal hemophagocytic syndrome showed no evidence of dissemination to nonsubcutaneous sites; lymph nodes, liver, and bone marrow revealed evidence only of hemophagocytosis.…”

Fatal Case of Subcutaneous Panniculitis T-Cell Lymphoma Mimicking Polyarteritis Nodosa: A Case Report and Review of Literature

“…An astute histopathologist can make the distinction based on histopathology, immunophenotyping, and clonal TCR gene rearrangement. Bone marrow involvement in SPTL is rare [7][8][9]. Features such as splenomegaly, pancytopenia, elevated lactate dehydrogenase, ferritin, and triglycerides are manifested in HS, while PAN is usually accompanied by anemia, thrombocytosis, and elevated acute phase reactants (erythrocyte sedimentation rate and Creactive protein).…”