CD30+ Large Cell Transformation of Mycosis Fungoides During Pregnancy
A 30 years old woman with history of scaling erythematous skin lesions since eight years ago was presented to MF clinic of Alzahra Hospital of Isfahan University of Medical Sciences. Lesions first has been appeared on the scalp then spreaded to whole body (erythroderma). Two years earlier skin biopsy has been done and Histologic diagnosis of skin biopsy was dermatitis.\nPhysical examination findings were: Erythroderma with severe scaling, palmoplantar keratoderma imitating acquired ichthyosis and bilateral ectropion []. No organomegally or lymphadenopathy was detected. Two skin-biopsy was performed, the first specimen histologically was compatible with dermatitis, but the Histologic evaluation of the second one confirmed the diagnosis of MF. Immunohistochemical (IHC) staining of specimens was done. The IHC staining revealed that the infiltrating cells were CD2+, CD4+, CD8-, CD45RO+, CD7-, CD30-. TCR gene rearrangement analysis, confirmed clonality.\nThe criteria for diagnosis of MF was completed (clinical criteria, IHC staining and TCR gene rearrangement analysis).\nAfter diagnosis of MF, Clinical staging was done. CBC, ESR, CRP, LDH, blood biochemistry, liver function tests and peripheral blood smear were within normal limits. Abdomino-pelvic and chest CT- scan were normal. Patient staged as stage IIIA, at this stage our treatment plan was systemic PUVA therapy (3 session per week) and interferon alfa 2B (3 million unit 3 session per weeks, SC) Two weeks later patient returned to our clinic and stated that she was pregnant. At this time our treatment plan changed to NB-UVB therapy, but she rejected this plan and interrupted treatment until delivery.\nOne week after delivery she returned for resuming the treatment plan. Physical examination revealed Ichthyosiform erythroderma with bilateral inguinal lymphadenopathy [].\nTwo weeks of antibiotic therapy was started but lymphadenopathy persisted. Skin and Lymph node biopsy was done. Histologic diagnosis was anaplastic CD30 + large-T-cell lymphoma. [Figures and ] IHC staining of specimens revealed that infiltrating cells had the following markers CD2+, CD5+, CD4+, CD8-, CD45RO+, CD7-, ALK1(-), CD30 strongly positive, KI67 positive in more than 90% [Figures -]\nBone Marrow biopsy was normal. Previous skin specimens were re-evaluated and anaplastic large cell transformation of MF was confirmed.