Cutaneous Metastasis of Hepatosplenic T-cell Lymphoma

Summary: Hepatosplenic T-cell lymphoma is a rare, aggressive subtype of peripheral T-cell lymphoma uncommonly presenting with cutaneous metastases. We present a 52-year-old man with relapsed stage IV hepatosplenic T-cell lymphoma status post three cycles of ICE (ifosfamide, carboplatin, etoposide) induction chemotherapy followed by BEAM (carmustine, etoposide, cytarabine, melphalan) conditioning chemotherapy, with autologous stem cell transplant rescue, with new asymptomatic, hyperpigmented, indurated plaques over his right upper back, left mid-abdomen, and right upper buttock. The patient was noted to have worsening pancytopenia one month prior to presentation with bone marrow biopsy demonstrating T-cell lymphoma involvement. PET/CT showed massive and hypermetabolic splenomegaly and diffuse lymphadenopathy with multiple hypermetabolic subcutaneous areas of uptake over areas of concern. A biopsy of the lesion on the right superior buttock showed findings consistent with cutaneous involvement of hepatosplenic T-cell lymphoma, with expression of CD2, CD3, CD7, and CD56 and negative stains including CD5 (aberrant loss), CD4, CD8, and CD30. Given prior excellent response and tolerability to upfront ICE, patient was re-induced with ICE with resolution of hypermetabolic lymphadenopathy and significant size reduction of cutaneous lesions on physical exam. Hepatosplenic T-cell lymphoma traditionally involves the liver, spleen and bone marrow; cutaneous manifestations are rare.