Fine-Needle Aspiration of

Subcutaneous Panniculitis-like
T-Cell Lymphoma
Frances Manosca, M.D., Reshma Ariga, M.D., Chafik Bengana, M.D.,
Vijaya B. Reddy, M.D., Jerome Loew, M.D., and Paolo Gattuso, M.D.*

We report the fine-needle aspiration (FNA) cytology findings of right inguinal region was performed. The cytological
Subcutaneous Panniculitis-like T-cell Lymphoma (SCPTCL) in a smears were air-dried and stained with the Diff-Quik
66-year-old woman who presented with a four month history of method. The cytological material was quite cellular, com-
asymptomatic subcutaneous nodules on her right chest wall and
back. An excisional biopsy of the right chest nodules was per- posed mainly of sheets of epithelioid histiocytes, benign
formed, and the diagnosis of SCPTCL was rendered. On a fol- histiocytes, and scattered multinucleated giant cells. How-
low-up visit, several skin lesions were noted throughout her body. ever, no distinct granulomas were noted (Fig. C-1). The
A fine-needle aspiration (FNA) of the right inguinal region was background of the cytological smears showed scattered
performed. The FNA yielded cellular smears, composed mainly of atypical lymphoid cells, some of which displayed nuclear
sheets of epithelioid histiocytes and scattered multinucleated cells.
envelope irregularities (Fig. C-2). The irregular folded nu-
However, no distinct granulomas were noted. The background of
the cytological smears showed scattered atypical lymphoid cells, clei made distinction of the histiocytes from atypical lym-
some of which displayed nuclear membrane irregularities. To the phocytes difficult.
best of our knowledge, the cytological features on FNA material of SCPTCL was first reported by Gonzalez at al.1 as a rare
SCPTCL have not been described. Diagn. Cytopathol. 2004;31: form of cutaneous lymphoma localized in the subcutaneous
338 –339. © 2004 Wiley-Liss, Inc. tissue mimicking lobular panniculitis. Recently, this lesion
has been recognized as a distinct clinicopathological entity
Key Words: subcutaneous panniculitis-like t-cell lymphoma; fine-
needle aspiration in the revised European-American classification of lym-
phoid neoplasms (R.E.A.L.) and World Health Organization
In August 2002, a 66-yr-old white woman presented with a
4-mo history of asymptomatic subcutaneous nodules on the
right chest wall and back. After initial treatment with anti-
biotics, the nodules on her back disappeared. However, the
lesions on the right chest wall persisted. An excisional
biopsy of the right chest nodules was performed, and a
diagnosis of subcutaneous panniculitis-like T-cell lym-
phoma (SCPTCL) was rendered. A few weeks later, without
further treatment, the skin lesions disappeared. For the next
several months, the patient remained free of disease. In
February 2003, the patient was seen in the oncology clinic
for a follow-up visit. Several skin lesions were noted
throughout her body. A fine-needle aspiration (FNA) of the

Department of Pathology, Rush-Presbyterian-St. Luke’s Medical Center,

Rush University, Chicago, Illinois
*Paolo Gattuso, M.D., Rush-Presbyterian-St. Luke’s Medical Center,
Rush University, 570 Jelke Building, 1750 W. Harrison St., Chicago, IL
60612. E-mail: Paolo_Gattuso@rush.edu Fig. 1. The cytological smears are cellular, composed of clusters of epi-
Received 30 July 2003; Accepted 12 May 2004 thelioid histiocytes (Diff-Quik; original magnification, ⫻400). [Color fig-
DOI 10.1002/dc.20125 ure can be viewed in the online issue, which is available at www.
Published online in Wiley InterScience (www.interscience.wiley.com). interscience.wiley.com.]

338 Diagnostic Cytopathology, Vol 31, No 5 © 2004 WILEY-LISS, INC.


Fig. 2. The background of the cytological smears show atypical lymphoid
cells, some of which show nuclear envelope irregularities (Diff-Quik;
original magnification, ⫻1,000; oil immersion). [Color figure can be
viewed in the online issue, which is available at www.interscience.
wiley.com.]
(WHO).2 Patients with SCPTCL usually present with mul-
tiple sub cutaneous nodules or plaques involving the trunk
or extremities; constitutional symptoms include fever, mal-
aise, fatigue, myalgia, chills, and weight loss.3 Patients with
SCPTCL also may manifest a systemic hemophagocytic
syndrome (HPS).3 The clinical course of SCPTCL usually is
aggressive with short survival.1,3 However, systemic dis-
semination of the disease is seen rarely, and some patients
with SCPTCL have an indolent clinical course with multiple
local recurrences and self-healing lesions.4 SCPTCL is a
clonal cytotoxic T-cell malignancy5– 6 histologically com-
posed of a variable admixture of benign histiocytes that may
form noncaseating granulomas. The atypical lymphoid in-
filtrate usually shows angiocentric predilection. Erythroph-
agocytosis may be seen; however, karyorrhectic nuclear
fragments usually are present in every case.
FINE-NEEDLE ASPIRATION OF SCPTCL
The cytological features on FNA material of SCPTCL, to
our knowledge, have not been described. The findings are
nonspecific; thus, it is difficult as a primary diagnosis.
SCPTCL is an unusual entity with different manifestations
and is a great mimic of granulomatous inflammation. How-
ever, the high cellularity, the absence of well-formed non-
caseating granulomas and the presence of scattered atypical
lymphoid cells in the background should prompt the con-
sideration of this entity in the differential diagnosis. The
lymphoid population may be difficult to distinguish between
reactive lymphocytes in a neoplasm and a granulomatous
reaction with atypical-appearing lymphocytes. Flow cytom-
etry and immunophenotypic markers may be helpful; how-
ever, they were not performed in this case because it was not
a primary diagnosis. In summary, the clinical history, clin-
ical appearance of the skin lesions, and the cytological
features should be taken in consideration before a diagnosis
of SCPTCL is rendered.
References
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