Interstitial Mycosis Fungoides Clinically Presenting as Lymphedema (ASDP 2023)
Punch biopsy of the right abdomen showed a fibrotic dermis and an interstitial infiltrate of small lymphocytes displaying nuclear hyperchromasia and irregular nuclear contours. An epidermotropic infiltrate of similar-appearing lymphocytes was found along the dermoepidermal junction. Immunohistochemistry was performed and demonstrated that lymphocytes express CD3, CD8, CD2, TCRβF1, and TIA1 and lack expression of CD7, TCRΔ, granzyme B, and CD56. CD68 and CD4 highlighted predominantly interstitial histiocytes. T-cell clonality studies demonstrated a clonal T-cell population. In conjunction with the clinical findings, a diagnosis of interstitial mycosis fungoides (IMF) was made. Given the unusual clinical findings without typical patches and plaques of conventional MF, knowledge of IMF is critical to prevent misdiagnosis of an inflammatory dermatosis.