RESUMEN
Cutaneous multilobated T-cell lymphoma is an uncommon variant of skin-based peripheral T-cell lymphoma typically characterized by cutaneous nodules in elderly patients and a chronic clinical course. We report a case of the disease that led to the patient's death within 2 years after onset. This disease may be associated with a more aggressive clinical course than generally recognized.
Asunto(s)
Linfoma Cutáneo de Células T , Neoplasias Cutáneas , Anciano , Núcleo Celular/ultraestructura , Humanos , Pierna , Metástasis Linfática , Linfoma Cutáneo de Células T/patología , Linfoma Cutáneo de Células T/ultraestructura , Masculino , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/ultraestructuraAsunto(s)
Anticuerpos Monoclonales , Neoplasias Gastrointestinales/radioterapia , Adulto , Anciano , Anticuerpos Monoclonales/efectos adversos , Ensayos Clínicos como Asunto , Femenino , Humanos , Radioisótopos de Yodo/efectos adversos , Radioisótopos de Yodo/uso terapéutico , Leucocitos , Masculino , Persona de Mediana EdadRESUMEN
Complete responses lasting from 4 to 14 years were documented in 65 of 331 (20%) patients with cutaneous T cell lymphoma treated with topical mechlorethamine (HN2) between 1968 and 1982. Such long-lasting remissions occurred most often, but not invariably, in patients with patch or plaque phase mycosis fungoides without palpable lymphadenopathy (stage Ia or Ib). The likelihood of a continuous remission was enhanced by initiation of treatment before an unequivocal pathologic diagnosis. Despite the long-lasting responses in these patients, however, relapses have been documented in 11 (17%) of these patients, and all relapses occurred within 8 years of discontinuing maintenance topical chemotherapy. Thus, in our experience, a continuous remission lasting 8 or more years provides evidence that cutaneous T cell lymphoma can be eradicated by aggressive topical chemotherapy. This circumstance was observed in 35 patients, representing a cure rate of at least 11% overall. In addition, when compared with the general population of the United States, patients who received topical HN2 were at an 8.6-fold and a 1.8-fold increased risk for the development of squamous cell carcinoma and enhanced for Hodgkin's disease and colon cancer but not for systemic cancers known to be induced by systemic administration of alkylating drugs. These results compare favorably with experiences with topical HN2 chemotherapy at other centers but raise questions about the risks associated with long-term administration for maintenance of remissions.