title: Successful treatment of a patient with subcutaneous panniculitis-like T-cell lymphoma with high-dose chemotherapy and total body irradiation.
abstract: A 24-yr-old man was referred for fever, right cheek swelling, subcutaneous tumor and liver dysfunction. Physical examination showed an elastic hard subcutaneous tumor on the right cheek, left axillary lymph node swelling and multiple small subcutaneous tumors in the trunk. Laboratory examinations showed elevated levels of transaminase, soluble interleukin-2 receptor and ferritin. Biopsy of the subcutaneous tumor showed proliferation of medium-sized cells with abundant clear cytoplasm and hyperchromatic nuclei among the subcutaneous fat tissues. These cells showed CD3+, CD4-, CD8+, CD56- and CD20- phenotype and possessed cytotoxic molecules such as granzyme B and T-cell intracellular antigen-1. Bone marrow aspiration showed proliferation of small numbers of abnormal lymphocytes with severe hemophagocytosis. He was thus diagnosed as having subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and treated with dose-escalated CHOP regimen. After three courses of the chemotherapy, he was further treated with high-dose chemotherapy and total body irradiation (TBI) with autologous peripheral blood stem cell rescue. Thereafter, he has been in remission for more than 2 yr. We consider that SPTCL with hemophagocytosis is an extremely aggressive disease, and high-dose chemotherapy and TBI should be included for the choice of the treatment.
authors.affiliation: Division of Hematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. hmukai@md.tsukuba.ac.jp
authors.forename: Harumi Y
authors.initials: HY
authors.lastname: Mukai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okoshi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Katsura
authors.forename: Naoko
authors.initials: N
authors.lastname: Takei
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kojima
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Mori
authors.forename: Toshiro
authors.initials: T
authors.lastname: Nagasawa
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001856:Bone Marrow Examination; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D018365:Neoplasm, Residual / Q000175:diagnosis; D015434:Panniculitis; D036102:Peripheral Blood Stem Cell Transplantation; D012074:Remission Induction / Q000379:methods; D040521:Subcutaneous Tissue / Q000473:pathology; D014916:Whole-Body Irradiation