Complete remission of an unusual form of unspecified peripheral T-cell lymphoma: a case report and review of the literature

Abstract

Introduction: Peripheral T-cell lymphomas have a poor prognosis with less common sustainable remissions after standard anthracycline-based chemotherapy. We report a case of isolated skin involvement of an unspecified peripheral T-cell lymphoma with an unremarkable outcome under chemotherapy. Observation: A 72-year-old hypertensive patient under treatment was seen in a hematology consultation for the management of a postero-lateral mass on theleft-hand first metacarpal, ulcerative-bulging with a clean background, rounded, firm, mobile, painless, measuring around 12 cm in length, and evolving for 4 months. Peripheral lymph nodes and other organs were unremarkable on examination. The patient underwent a biopsy of the mass.Histological examination of the specimen showed a malignant proliferation made up of medium-sized rounded cell layers with reduced cytoplasm and irregular nuclei with nucleated patterns sometimes. The stroma was densely fibrous and mitoses were quite frequent. On immunohistochemistry, the cells were CD3 positive, CD5, CD4, CCD8, CD7, CD25, CD20 and melan A negative. Perforin, FOXP3, CD30, and Pan cytokeratins were also negative. Ki67 was 80%. The hand X-raydidn’tidentify bone involvement. The biological work-up was unremarkable. The thoracic-abdominal-pelvic CT scan was normal. The diagnosis of nonspecific T-lymphoma stage IE Ann Arbor and IPI 2 was set. After 6 cycles of Cyclophosphamide-Doxorubicin-OncovinPrednisone chemotherapy, we obtainedcomplete tumor remission. MRI of the left hand aftermanagement showed a focal subcutaneous thickening opposite the 1st ray, without any underlying mass syndrome. After 3 months, the patient had a good general condition with no clinical recurrence. Conclusion: This case illustrates an unusual location of an unspecified peripheral T-cell lymphoma with a complete response after standard anthracycline-based chemotherapy. The short-term prognosis is unremarkable.