Subcutaneous panniculitislike T-cell lymphoma appearing as a breast mass: A difficult and challenging case appearing at an unusual site

Abstract

Subcutaneous panniculitislike T-cell lymphoma (SPTCL) is a rare subtype of cutaneous lymphoma. It appears clinically with erythematous, subcutaneous infiltrates and recurrent papulonodules. It is rare in young patients, with only a few reported cases. We report the case of a 23-year-old healthy woman with an atypical appearance of SPTCL. She initially came to our institution with a 3-month history of a left breast mass. Biopsy showed scattered reactive macrophages, multinucleated giant cells, and mixed lymphoid infiltrates suggestive of acute panniculitis. Her condition improved clinically with conservative treatment. More than 3.5 years later, multiple painful, self-remitting crops of skin nodules developed over her extremities, associated with intermittent low-grade fever, night sweats, and weight loss. The diagnosis of SPTCL was finally made from a skin biopsy obtained from her forearm. Hemophagocytosis, a known, often fatal complication, was not evident. She received combination chemotherapy with fludarabine, mitoxantrone, and dexamethasone with good response. The initial breast biopsy specimens were reexamined. Deeper sections revealed the presence of some atypical lymphoid cells but with inadequate features for the diagnosis of SPTCL. However, the clinical improvement of her breast condition with combination chemotherapy is supportive of involvement of a lymphomatous process. We review her clinical appearance, radiologic findings, histologic features, treatment, and outcome. To the best of our knowledge, SPTCL appearing as a breast mass has not been reported previously, and this report stresses the importance of repeated biopsy when SPTCL is suspected. © 2005 by the American Institute of Ultrasound in Medicine.