Granulomatous Variant of Cutaneous T Cell Lymphoma: A Case of Leukemic Form with Monocytosis

Abstract

A 26 year-old Japanese woman presented with multiple cutaneous nodules exhibiting spontaneous regression and periperal blood monocytosis. Histopathology of the cutaneous nodule showed massive dermal infiltration of CD4 positive tumor cells and a granuloma formation composed of CD68 positive histiocytes and multinucleated giant cells. Southern blotting analysis for DNA extracted from nodule-infiltrating lymphocytes and peripheral blood mononuclear cells, detected monoclonal rearranged bands for T cell receptor. Although the peripheral blood findings showed massive proliferation of CD14 positive monocytes, no atypical lymphoctes were detected. The patient was diagnosed as having a slightly leukemic form of a granulomatous variant of cutaneous T cell lymphoma with peripheral monocytosis. She has been in good health with oral etretinate and PUVA therapy. It is suggested that granuloma formation, monocytosis and an indolent clinical course were closely associated in our case.