Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 25

SHORT COMMUNICATION 651 Telangiectatic Mycosis Fungoides: A New Clinicopathological Presentation Mimicking Acquired Naevoid Telangiectasia Lidia GARCÍA-COLMENERO, Laia CURTO-BARREDO, Ignacio GÓMEZ-MARTIN, Fernando GALLARDO and Ramon M. PUJOL Department of Dermatology, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25–29, ES-08003 Barcelona, Spain. E-mail: lidia.garcia. [email protected] Accepted Jan 12, 2017; Epub ahead of print Jan 17, 2017 Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. The classical clinical picture usually evolves through 3 stages: patch, plaque and tumour stage. However, multiple clinicopathological variants of MF have been reported and a considerable number of reports have documented MF lesions mi- micking different inflammatory and non-inflammatory cutaneous disorders. In these situations the diagnosis can be challenging and additional studies (histopathological, immunohistochemical and molecular analysis) may be necessary in order to establish a definite diagnosis. We report here an uncommon clinical presentation of MF manifested by multiple isolated non-atrophic patches with prominent telangiectasias and, histopathologically, by an epidermotropic lymphocytic infiltrate accompanied by dilated capillaries in the reticular dermis. This “te- langiectatic” variant of patch-stage MF seems to expand the clinicopathological spectrum of early MF lesions. CASE REPORT A 52-year-old man with personal history of arterial hyperten- sion treated with perindopril was referred to our department for evaluation of a 6-month history of asymptomatic erythematous patches on the face, trunk and upper extremities. Physical exami- nation revealed an apparently healthy man with several round-to- oval-shaped patches ranging from 2 to 15 cm in diameter on the abdomen (Fig. 1a), left arm (Fig. 1b) and left temple. The lesions were discrete erythematous patches with multiple, blanching, scattered, 1–3 mm telangiectasias diffusely distributed over the surface. Neither skin atrophy, nor hypo- or hyper-pigmented areas were present. The rest of the physical examination was unremarkable. The patient denied any alcohol consumption or previous treatments with oral calcium blockers or topical corti- costeroids. Dermoscopy revealed abundant telangiectasias and tortuous vessels associated with red-brownish patchy areas on the entire lesion (Fig. 1c). Skin biopsies from 2 different patches were performed, which revealed an atypical band-like epidermotropic lymphocytic infiltra- tion along the basal layer and upper dermi s, surrounding prominent dilated vessels (Fig. 2a). Scattered intraepidermal atypical lym­ phocytes were observed without clear-cut Pautrier’s microabscess formation (Fig. 2b). No epidermal atrophy was present. Immu- nohistochemically, atypical lymphocytes were positive for CD3 and CD4 (Fig. 2c) and a decreased expression of CD7 antigen was noted. B-cell markers were all negative (CD20, CD10, CXCL13), as well as CD30 and c-kit (CD117). Ki67 labelling index was ap- proximately 10%. A monoclonal lymphoid T-cell population was detected by PCR for both T-cell receptor (TCR) gamma and beta chains. Results of blood examination including blood cell count, liver function tests, lactate dehydrogenase and B2-microglobulin blood levels, as well as results of chest radiography and abdominal ultrasonography were unremarkable. Treatment with potent topical corticosteroids was prescribed and a clinical improvement in the lesions was observed. During the following months 2 new telangiectatic patches developed on the abdomen and right armpit, of smaller size than the previous ones. DISCUSSION MF has a wide range of clinicopathological manifesta- tions, some of which differ substantially from the clas- sical presentation. Many different clinical variants of MF have been described including poikilodermic, follicular, bullous, granulomatous, hypopigmented, hyperpigmen- ted, hyperkeratotic, pustular, ichthyosiform or erythro- dermic forms (1–4). In addition, MF and, specifically, in early stages may adopt atypical clinical presentations and mimic a wide range of cutaneous disorders (5). Our patient presented several non-atrophic patches with prominent linearly distributed telangiectasias Fig. 1. Clinical presentation and dermoscopic features: erythematous asymptomatic patches with prominent telangiectatic vessels on (a) the abdomen and (b) the left arm. (c) Abundant telangiectasia and smaller tortuous vessels associated with red-brownish patchy areas at dermoscopy. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2613 Acta Derm Venereol 2017; 97: 651–652