Pagetoid Reticulosis: A Rare Dermatologic Malignancy Presenting in a Middle-Aged Female

Abstract

Pagetoid reticulosis is a rare form of cutaneous T cell lymphoma, a malignancy of T lymphocytes, that invades the skin leading to a multitude of dermatologic manifestations. Pagetoid reticulosis commonly presents as a localized slow-growing or indolently manifesting hyperkeratotic patch/plaque on the extremities that is confined to the epidermis. Diagnosis is confirmed via a skin biopsy of the affected area followed by a cytologic examination. Treatment typically entails topical corticosteroids, alkylating agents, and retinoids. With disseminated disease, a multidisciplinary approach involving chemotherapy and radiation is necessary. To raise awareness about pagetoid reticulosis, its diagnosis, and management, we report a case localized to the left forehead and earlobe of a 57-year-old female.

Keywords: clinical dermatology; cutaneous t cell lymphoma; dermatopathology; pagetoid reticulosis; resistant dermatitis.

Figure 1. Pagetoid reticulosis presenting as a scaling hyperkeratotic plaque on the forehead of the patient.

Figure 2. Pathology slide showing the full 3 mm punch biopsy obtained from the right forehead of the patient, which was positive for pagetoid reticulosis.

Figure 3. Biopsy specimen showing a periadnexal inflammatory infiltrate accompanied by dense intraepidermal mononuclear cell aggregates.

Figure 4. Higher-power view of the biopsy specimen showing the intraepidermal mononuclear cell aggregate with enlarged hyperchromatic nuclei, irregular nuclear borders, and abundant clear cytoplasm.