Subcutaneous Panniculitis-like T-lymphoma (SPTL) is a rare non-epidermotropic cutaneous T cell lymphoma, which perform
1% of all non-Hodgkin’s lymphomas. The lesions are usually localized in the upper limbs and the trunk. the localization on the
cheeks is unusual. The diagnosis of SPTCL depends on the pathologic examination of skin biopsy, but the manifestations of SPTCL
are varied and mimic autoimmune disorders. We report a case of a subcutaneous panniculitis-like t-cell lymphoma with an unusual
localization in the cheek, mimicking a lupus erythematosus panniculitis, evolving since 2 years in a 40-year-old woman.
Subcutaneous Panniculitis-like T-lymphoma (SPTL) is a rare
non-epidermotropic cutaneous T cell lymphoma. The lesions are
usually localized in the upper limbs and the trunk. the localization
on the cheeks is unusual [1]. The diagnosis of SPTCL depends on
the pathologic examination of skin biopsy, but the manifestations
of SPTCL are varied and mimic autoimmune disorders. We report a
rare case of a subcutaneous panniculitis-like t-cell lymphoma of the
cheek evolving since 2 years in a 40-year-old woman.
A 40-year-old woman presented with painless skin lesions in
the both cheeks. The lesions appeared 2 years earlier as a nodule
that has evolved into plaque. Clinical examination revealed a large
rounded infiltrated plate in the cheek, bilateral, measuring 5 cm
on the right and 3 cm on the left, flesh-colored with cuculiform
depression. She had no other symptoms, organomegaly, or
lymphadenopathy. Histopathological examination of a deep skin
biopsy revealed a lymphoid infiltrate dissociating adipocyte,
made of atypical cells with round nucleus and delicate chromatin.
immunohistochemistry of atypical cells was positive for CD3 and
CD8 and negative for CD20, CD4, CD5 and CD56. Positron emission
tomography (PET) of the whole body showed subcutaneous
thickening of the cheeks, with localization in the vertebral bone
without regional lymph node. Biological examinations have not
revealed signs of macrophage activation syndrome. With all this
finding, the diagnosis of subcutaneous panniculitis-like T-cell
lymphoma (SPTCL) was made and a chemotherapy was indicated
for this patient (Figures 1 & 2).
Figure 1: Infiltrated plate in the left cheek with cuculiform
depression.
Figure 2: Skin biopsy showing a lymphoid infiltrate
dissociating adipocyte, made of atypical cells with round
nucleus and delicate chromatin (HE x 10).
SPTCL is a uncommon cutaneous T-cell lymphoma, which
perform 1% of all non-Hodgkin’s lymphomas. it was first reported
by Gonzalez in 1991 [2], then described by the World Health
Organization as a distinguish entity in 2001[3]. It affects the young
adult; the median age of the diagnosis is 39 years. Clinically, SPTCL
is characterized by indolent evolutionary lesions, Plaque type,
painless subcutaneous nodules or necrotic ulcers, sometimes
associated with mucosal involvement. Generally, the lesions are
localized at the extremities and the trunk, the localization on
the cheek is extremely rare. The differential diagnosis in this
localization arises at the beginning with the benign panniculitis, the
eczema and the cellulite and especially with the lupus panniculitis
at a late stage. Our patient had an atypical clinical manifestation
with cuculiform scars suggestive of lupus panniculitis, for which
she had an assessment of lupus, but it was normal.
There are two types of SPTCL [4]: an αβ (SPTCL-AB) and a γδ
subtype (SPTCL-GD).1 SPTL-ABs generally have a CD4-/CD81/
CD56- T-cell phenotype and a favorable prognosis, whereas SPTLGDs
typically have a CD4- /CD8- T-cell phenotype with frequent
coexpression of CD56, a higher association with hemophagocytic
syndrome, and a poor prognosis. The diagnosis of SPTCL is
based on clinical, histological and immunohistochemical criteria.
The treatment is essentially based on chemotherapy with
cyclophosphamide, doxorubicin, vincristine and prednisolone, with
an overall remission rate of 50% [5]. In some cases, an autologous
bone marrow transplant may be indicated. The overall survival rate
of the Tcell receptor at 5 years exceeds 80%.
In conclusion, we reported a case of SPTL with a very
rare localization in the cheeks, which almost always poses the
problem of differential diagnosis with autoimmune diseases, and
specifically lupus panniculitis in our case. Hence the interest of a
good interrogation and a complete clinical examination in front of a
subcutaneous nodules of the cheeks.