Cutaneous EBV-positive γδ T-cell lymphoma vs. extranodal NK/T-cell lymphoma: a case report and literature review

Authors

  • Wei-Wen Yu,

    1. Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
    2. Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Pin-Pen Hsieh,

    1. Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
    2. Center for General Education, Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
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  • Shih-Sung Chuang

    Corresponding author
    1. Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
    2. Department of Pathology, Taipei Medical University, Taipei, Taiwan
    • Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Shih-Sung Chuang, MD,

Department of Pathology, Chi-Mei Medical

Centre, 901 Chung-Hwa Road, Yung-Kang

District, Tainan 710, Taiwan

Tel: +886 6 281 2811 ext. 53686

Fax: +886 6 251 1235

e-mail: cmh5301@mail.chimei.org.tw

Abstract

Primary cutaneous γδ T-cell lymphoma and extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type are two distinct lymphoma entities in the World Health Organization (WHO) classification. We report the case of an aggressive cutaneous lymphoma of γδ T-cell origin showing overlapping features of both lymphomas. A 78-year-old female presented with confluent erythematous plaques with ulcerations over her right thigh. Microscopically, section of the skin showed a diffuse dermal and subcutaneous lymphocytic infiltration with tumor necrosis and angioinvasion. The medium- to large-sized tumor cells expressed CD3, CD8, cytotoxic molecules and T-cell receptor (TCR)-γ but not CD4, CD20, CD30, CD56 or βF1. In situ hybridization for Epstein-Barr virus-encoded mRNA (EBER) was diffusely positive. Polymerase chain reaction-based clonality assay showed a clonal TCR-γ chain gene rearrangement. The features compatible with γδ T-cell lymphoma include dermal and subcutaneous involvements, cytotoxic phenotype, expression of TCR-γ, as well as an aggressive course. On the other hand, the diffuse EBER positivity, angioinvasion, tumor necrosis and cytotoxic phenotype may also fit in the diagnosis of an ENKTL of T-cell lineage. We review the literature on EBER-positive γδ T-cell lymphoma and discuss the diagnostic dilemma using the current WHO classification system.

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