Cerebrospinal fluid infiltration of primary cutaneous gamma delta T-cell lymphoma

[摘要] A 63-year-old man recognised a growing cutaneous elevation onhis left palm that reached 6 cm in diameter within 2 months.A histological examination revealed a diagnosis of primary cutaneous gamma delta T-cell lymphoma (PCGD-TCL) (Figure 1, panels A and B). Positron emission tomography showed tumour involvement in the left palm, left arm, left axillary and subclavian lymphnodes, and prostate gland, suggesting his disease was clinical stageIV. After receiving four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone), he suddenly developed leftfacial and oculomotor nerve palsy. Gadolinium-enhanced magneticresonance imaging showed no brain lesion. However, cerebrospinalfluid (CSF) pleocytosis (87 cells/μl) was observed, accompanied byabnormal lymphoid cells that were medium to large in size with anucleus harbouring fine chromatin formation and multiple nucleolusas well as an irregular cytoplasm contour (Figure 1, panel C). Thecells were positive for CD3, CD5 and TCRγδ but not CD4, CD7 orCD8 (Figure 1, panel D, orange), demonstrating CSF infiltration ofPCGD-TCL.