Progressive and painful wound as a feature of subcutaneous panniculitis-like T-cell lymphoma (SPTCL): report of a case and review of literature

Abstract

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an uncommon extranodal non-Hodgkin lymphoma, with an aggressive course with no well-defined treatment. This article describes a 56-year-old man, treated surgically 7 months earlier for a subcutaneous nodosity near the left axilla, presenting with a progressive inflamed wound, pain, and high fever (39 °C). Treatment with systemic antibiotics and topical anti-inflammatory dressings failed. After 7 months, the patient was diagnosed with SPTCL based on biopsy results and a multidisciplinary consultation. While undergoing systemic chemotherapy with corticosteroid therapy, his wound become more painful, larger, and covered with necrotic tissue. Fifty days after chemotherapy with corticosteroid therapy, his wound became seriously painful and increasingly necrotic. He developed a serious stomachache and abdominal distension, rapidly became comatose, and died. The aim of this case report is to present our experience of the different clinical signs of SPTCL to expedite its early diagnosis in future. We summarize the main clinical characteristics of SPTCL as a rapidly progressing and increasingly painful wound with necrotic tissue, involving a multisystem disorder, which is easily misdiagnosed, responds poorly to corticosteroid and chemotherapy treatments, and has a high mortality rate. The pathological characteristics are early inflammation, advancing to profuse infiltration of the subcutaneous adipose tissues by CD3(+) and/or CD8(+) T-cell lymphoma cells. Clinicians must cooperate with pathologists and oncologists to diagnose this disease as soon as possible and to avoid a misdiagnosis. The use of antibiotic and painkillers should minimize the patient's discomfort and control rapid wound development. Future studies are required to investigate the optimal wound treatment and whether the necrotic tissue should be removed.

Keywords: Wound; clinical characteristic; pathology; subcutaneous panniculitis T-cell lymphoma.

Figure 1

The initial assessment was of a full-thickness wound of 4 cm × 10 cm, wholly covered with necrotic tissue, and involving the fatty layer and part of the muscle layer (A). After treatment for 2 weeks, the wound tissue showed 25% fresh granulation, but still tended to increase in size (B), and the WRP score had decreased to 5-6 points. After 4 weeks of treatment, inflammation was controlled, the pain had eased further, and the area of black necrosis had decreased (C). Fifty days after chemotherapy with corticosteroid therapy and wound care, the wound became seriously painful and increasingly necrotic (D).

Figure 2

The immunohistochemical staining was used in diagnosis of SPTCL. A: CD2 (3+); B: CD3 (3+); C: CD20 (-); D: CD43 (3+); E: CD56 (3+); F: MPO (-); G: CD163 (+); H: Ki67 (90%+); I: GranB (3+).