title: Primary cutaneous γδ-T-cell lymphoma treated with low-dose methotrexate and narrowband ultraviolet B irradiation: report of a case with testicular involvement.
abstract: Primary cutaneous γδ-T-cell lymphoma (CGD-TCL) is a rare entity of cutaneous T-cell lymphomas (CTCL) and is characterized by tumoral growth of mature γδ-T-cell expressing cytotoxic molecules. The prognosis of CGD-TCL is generally worse than other CTCL. However, relatively indolent patch/plaque lesions have been described suggesting the heterogeneous nature of this entity. Here, we present a case of CGD-TCL with various skin manifestations, such as erythematous plaques/tumors and subcutaneous panniculitis-like lesions. During the follow up, testicular involvement was detected, which was surgically removed. Histopathology showed mixed features from epidermotropism, dermal infiltration and subcutaneous panniculitis-like lesions depending on the clinical manifestations. The tumor cells were positive for CD3 and revealed cytotoxic markers, TIA-1 and perforin, but not for CD4, CD8, CD20, CD56, TCRβF1 or EBER. Topical glucocorticoid ointment, narrowband ultraviolet B (NB-UVB) irradiation and low-dose methotrexate (MTX) were effective to control these skin lesions. No visceral involvement was detected thereafter. While CGD-TCL is usually associated with poor prognosis, it seems to be composed of various clinical manifestations, and NB-UVB and low-dose MTX could be a choice for indolent patch/plaque and possibly nodular lesions, especially for the aged.
authors.affiliation: Department of Dermatology, Asahikawa Medical College, Asahikawa, Japan. ma0dj@asahikawa-med.ac.jp
authors.forename: Mizue
authors.initials: M
authors.lastname: Fujii
authors.forename: Jiro
authors.initials: J
authors.lastname: Uehara
authors.forename: Masaru
authors.initials: M
authors.lastname: Honma
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Akemi
authors.initials: A
authors.lastname: Ishida-Yamamoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Iizuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000378:metabolism; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D014467:Ultraviolet Therapy
chemical_list: D000970:Antineoplastic Agents; D016692:Receptors, Antigen, T-Cell, gamma-delta; D008727:Methotrexate