Complete Resolution of Primary Cutaneous Anaplastic Large Cell Lymphoma With Topical Imiquimod
May 2019 | Volume 18 | Issue 5 | Case Reports | 460 | Copyright © May 2019
Shelby L. Kubicki,a Katherine E. Park,b,c Phyu P. Aung MD PhD,d Madeleine Duvic MDc
aSchool of Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX bSchool of Medicine, Baylor College of Medicine, Houston, TX cDepartment of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX dDepartment of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
Treatment was initiated with imiquimod 5% cream five times weekly and mupirocin 2% ointment two times weekly. At theeight-week follow up for possible surgical resection, the lesion was completely resolved with no adverse events (Figure 1b).
Pc-ALCL is a CD30+ T-cell subtype of CTCL. Clinically, it presents with primary or multiple erythematous papules or nodules, mostcommonly on the leg.2 Pc-ALCL affects males more frequently than females (3:1), with a median age of diagnosis of 55 years. It has an indolent clinical course and five-year survival rate of 85- 100%. Diffuse skin involvement, initial presentation on the head and neck, and extensive disease on a single limb are associated with a worse prognosis.2
Histologically, pc-ALCL is characterized by a dense dermal infiltrate comprised of >75% CD30+ lymphocytes with paleeosinophilic cytoplasm.3
Most are positive for CD4 and demonstrate loss of CD2, CD3, and CD5. T-cell receptor gene translocations are observed in most cases.The differential diagnosis for pc-ALCL includes systemic ALCL with cutaneous involvement, lymphomatoid papulosis (LyP), and CD30+ mycosis fungoides (MF). Compared to systemic