Bari A U, Siemeen Ber Rahman.
Cutaneous T cell lymphoma presenting as Tumer de` emblee.
Pak J Pathol Jan ;13(2):38-40.

A 40 years old patient, smoker but non addict, presented with one year history of an expanding ulcerated growth over right knee region. It started initially as a small erythematous nodule that gradually increased in size transforming into a large firm irregular growth. About three months back he started having pain and ulceration in the growth. These symptoms considerably increased in intensity during last one month along with development of foul smelling purulent discharge with in the swelling. The growth expanded rapidly during that period, which reduced significantly the mobility of his right knee joint. The intense pain and foul smelling discharge from the lesion affected greatly the quality of his life. There was no history of any associated fever, lethargy, cough, urinary or bowel complaints. Lymphadenopathy was not present and systemic examination was also unremarkable. At the time of presentation the lesion was found to be a huge fungating roughly oval shaped tender growth measuring 40cm x 15cm in greatest dimensions having crythematous, rolled and indurated edges. The surface was irregular with ulceration and crusting at places. Considering outlook and rapid progression of the growth it was suspected to be a Squamous cell carcinoma. The other differential diagnosis included deep mycosis and cutaneous lymphoma. The patient was thoroughly investigated. Fungal and mycobacterial cultures were negative. Histopathology revealed atrophic epidermis with deep dermal dense infiltrate of lymphocytes, which were monomorphic and atypical. These finding were consistent with the diagnosis of CTCL that was confirmed by immunohistochemistry. Immunophenotypic markers revealed expression of CD3 (pan T-cell maker) 65%, CD8 (suppresser T-Cell marker) 43%, CD7 (T-cell receptor marker) 21% CD4 (helper T-cell marker) 19% CD19 (B-cell marker) 12%. Bone marrow examination revealed reactive hyperplasia without any evidence of infiltration. Atypical lymphocytes were also absent in peripheral blood. Based on clinical course and laboratory findings a final diagnosis of CTCL (MF, Tumer de` emblee type) was made.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com