Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder nodule successfully treated with laser Co2 ablation: a case report and literature review
https://doi.org/10.4081/dr.2024.9884
Accepted: 10 December 2023
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This case report describes an 83-year-old patient with a history of non-melanoma skin cancer who presented with a violaceous, painless nodule on the neck. Dermoscopic examination and subsequent biopsy revealed a Small/Medium CD4+ T-cell lymphoproliferative disorder (SMPLPD) of the skin. Although excision was initially recommended, the patient opted for treatment with CO2 laser ablation. The procedure had some minor complications but resulted in successful healing. SMPLPDs are a rare skin condition with limited treatment data, and this case suggests that CO2 laser ablation with minimal margins could be a viable alternative for selected patients, reducing bleeding and promoting second-intention healing for small nodules. However, more extensive follow-up data for SMPLPD cases are needed to understand long-term outcomes better.
Ungureanu L, Vasilovici A, Șenilă SC, Cosgarea I, Boda D. Dermoscopy in the diagnosis of cutaneous lymphoma (Review). Exp Ther Med. 2022 Jun;23(6):377. doi: 10.3892/etm.2022.11304. Epub 2022 Apr 7. PMID: 35495594; PMCID: PMC9019729. DOI: https://doi.org/10.3892/etm.2022.11304
Grogg KL, Jung S, Erickson LA, McClure RF, Dogan A. Primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoma: a clonal T-cell lymphoproliferative disorder with indolent behavior. Mod Pathol. 2008 Jun;21(6):708–15. DOI: https://doi.org/10.1038/modpathol.2008.40
Bakr F, Wain EM, Barlow R, Robson A. Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder or Primary Cutaneous Marginal Zone B-Cell Lymphoma? Two Distinct Entities With Overlapping Histopathological Features. Am J Dermatopathol. 2021 Dec 1;43(12):e204–12. DOI: https://doi.org/10.1097/DAD.0000000000002003
Plumptre IR, Said JT, Sun T, Larocca C, Virgen CA, Kupper TS, et al. Clinical features and treatment outcomes for primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder: a retrospective cohort study from the Dana-Farber Cancer Institute and updated literature review. Leuk Lymphoma. 2022 Dec;63(12):2832–46. DOI: https://doi.org/10.1080/10428194.2022.2098287
Bakr F, Wain EM, Wong S, Palmer R, Robson A. Prominent Blasts in Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder. A Reconsideration of Diagnostic Criteria. Am J Dermatopathol. 2021 Dec 1;43(12):e190–6. DOI: https://doi.org/10.1097/DAD.0000000000001979
Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375–90. DOI: https://doi.org/10.1182/blood-2016-01-643569
Alberti Violetti S, Alaibac M, Ardigò M, Baldo A, DI Meo N, Massone C, et al. An expert consensus report on mycosis fungoides in Italy: epidemiological impact and diagnostic-therapeutic pathway. Ital J Dermatol Venerol. 2021 Aug;156(4):413–21. DOI: https://doi.org/10.23736/S2784-8671.20.06668-7
Pileri A, Morsia E, Zengarini C, Torre E, Goteri G, Quaglino P, et al. Epidemiology of cutaneous T-cell lymphomas: state of the art and a focus on the Italian Marche region. European Journal of Dermatology. 2023 Jul 1;33(4):360–7. DOI: https://doi.org/10.1684/ejd.2023.4531
Ayala D, Ramón MD, Cabezas M, Jordá E. Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoma With Expression of Follicular T-Helper Cell Markers and Spontaneous Remission. Actas Dermosifiliogr. 2016 May 1;107(4):357–9. DOI: https://doi.org/10.1016/j.adengl.2016.02.013
Yi LG, Gru AA. Primary Cutaneous CD4-Positive Small/Medium T-Cell Lymphoproliferative Disorder Mimicking Jessner Lymphocytic Infiltrate and Tumid Lupus-A Report of Two Cases. Am J Dermatopathol. 2021 Dec 1;43(12):e293–7. DOI: https://doi.org/10.1097/DAD.0000000000001982
Salah E. Primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoproliferative disorder: Where do we stand? A systematic review. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2019 Feb;17(2):123–36. DOI: https://doi.org/10.1111/ddg.13691
Gru AA, Wick MR, Eid M. Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder-clinical and histopathologic features, differential diagnosis, and treatment. Semin Cutan Med Surg. 2018 Mar;37(1):39–48. DOI: https://doi.org/10.12788/j.sder.2018.006
Kim J, Jeong M, Jun D, Lee M, Shin D, Kim W, et al. Primary cutaneous CD4+ small/medium T-cell lymphoma: a case report. Arch Craniofac Surg. 2021 Aug;22(4):199–203. DOI: https://doi.org/10.7181/acfs.2021.00199
Kim EJ, Aria AB, Wilmas K, Lewis DJ, Torres-Cabala CA, Nunez C, et al. Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder in a pediatric patient successfully treated with low-dose radiation. Pediatr Dermatol. 2019 Jan;36(1):e23–6. DOI: https://doi.org/10.1111/pde.13728
Valentim F de O, Oliveira CC, Miot HA. Case for diagnosis. Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. An Bras Dermatol. 2019;94(1):99–101. DOI: https://doi.org/10.1590/abd1806-4841.20198513
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