LB936 Cutaneous T-cell lymphoma (CTCL) following B-cell lymphoma: A case series

Abstract

Cutaneous T-cell lymphoma (CTCL) is associated with an increased risk of developing secondary malignancies, particularly lymphomas. However, the diagnosis of lymphoma prior to CTCL is very rare. Herein we present the cases of two patients diagnosed with lymphoma prior to a diagnosis of CTCL. The first patient was a female in her late 50s with a history of diffuse large B-cell lymphoma (DLBL) of her breast status post chemo plus radiation who developed poikilodermatous scaly patches on her arms and legs one year after her DLBL diagnosis. Her condition was initially managed as an eczema refractory to treatment until a biopsy performed at an outside clinic several years later revealed likely CTCL followed by confirmative biopsies demonstrating poikiloderma atrophicans vasculare. She was treated with acitretin 10 mg five times weekly and narrowband UVB twice weekly for 12 treatments, but self-discontinued both. She recently initiated monthly extracorporeal photopheresis. The second patient was a female in her 70s with history of melanoma who presented to outpatient dermatology for evaluation of erythematous macules on her groin pending radiation treatment for DLBL of her breast. The rash was refractory to topical therapies and a biopsy later demonstrated mycosis fungoides. The patient initially preferred conservative therapy with natural sunlight and topical hydrocortisone, but ultimately elected for monthly photopheresis as her disease progressed. The response of both patients to photopheresis is yet to be determined. These cases illustrate the importance of full workup for erythematous, scaly rashes especially in the setting of other malignancy and in rashes refractory to topical treatments for other conditions. Both cases had at least one biopsy unrevealing of the true underlying CTCL diagnosis, showing that multiple biopsies may be necessary to capture this diagnosis.