Peripheral T-Cell Lymphoma Presenting as a Scalp Mass

Abstract

Peripheral scalp T-cell lymphoma is a very rare disease. We report a case of a 22-year-old man who presented an indolent large scalp mass in the right frontal scalp region. The patient's physical examination demonstrated no palpable mass in the chest, abdomen, and extremities. The brain CT revealed a high-density large scalp mass of the subgaleal layer in the right frontal and a small scalp mass of the subgaleal layer in the left frontal. The brain MRI showed multifocal enhancing masses in the bilateral dura, the subgaleal layer of the scalp, and the skull. The patient underwent removal of the tumor found in the right frontal scalp. The histologic diagnosis was peripheral T-cell lymphoma. Bone marrow aspiration showed the involvement of T-cell lymphoma. The patient received chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP protocol) for 3 cycles. The patient was discharged without neurological deficit. The patient showed no evidence of recurrence 15 months after surgery. We report a rare case of peripheral T-cell lymphoma mimicking benign scalp tumors.

Keywords: Lymphoma; Mass; Scalp.

Fig. 1. CT shows enlarged frontal large scalp mass. A: Axial view non-contrast. B: Coronal view non-contrast.

Fig. 2. MRI demonstrating multifocal homogeneously enhancing lesions in the bilateral dura (A) and multiple T2-hyperintense and homogeneously enhancing mass-like lesions involving subgaleal layer of the scalp, left forehead, and left superior orbit, multiple ill-defined enhancing lesions in the skull (B).

Fig. 3. PET-CT shows mildly hypermetabolic lesions in the lymph nodes in the neck (A) and a diffuse increase of FDG uptake in the bone marrow through the entire body, the right parotid gland, and the anterior mediastinum, the frontal scalp (B).

Fig. 4. Histopatholgy shows peripheral T-cell lymphoma. A: Diffuse infiltrates of medium-sized lymphoid cells with irregular nuclei (H&E, ×400). Tumor cells were positive for CD3 (B, ×400), negative for CD20 (C, ×400), and positive for CD8 (D, ×400). All follicular helper T cell markers (CD10, BCL6, PD-1) were not expressed.