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Camille E. Introcaso, MD; Ellen J. Kim, MD; Jennifer Gardner, MD; Jacqueline M. Junkins-Hopkins, MD; Carmela C. Vittorio, MD; Alain H. Rook, MD

Arch Dermatol. 2008;144(8):1027-1029.

Background  Most cutaneous T-cell lymphomas demonstrate a malignant population with a CD4⁺ phenotype. In rare cases, CD8⁺ phenotypes have been described based on immunostaining of skin specimens. Although some CD8⁺ lymphomas have an indolent course, others, such as CD8⁺ epidermotropic cytotoxic T-cell lymphomas, are typically more aggressive. To our knowledge, involvement of peripheral blood or cerebrospinal fluid with a malignant population of CD8⁺ cells demonstrated by flow cytometry and T-cell receptor gene rearrangement has not been previously described.

Observations  We describe a patient with a CD8⁺ cutaneous T-cell lymphoma with an initially indolent course and early stage diagnosed on the basis of a skin biopsy specimen. However, when flow cytometry was performed looking specifically at CD8⁺/CD4^– cells in the peripheral blood and cerebrospinal fluid, a malignant population of CD8⁺/CD4^–/CD26^–/CD7^– cells was discovered.

Conclusions  It is important for prognosis and treatment to be able to identify CD8⁺ epidermotropic cytotoxic T-cell lymphoma and separate it from other relatively indolent CD8⁺ lymphomas. Furthermore, detection of an abnormal CD8⁺/CD26^–/CD7^– T-cell population within the peripheral blood has important prognostic and therapeutic implications. The use of flow cytometry looking for abnormal CD8⁺ populations in the peripheral blood or cerebrospinal fluid can assist with this critical information.

Author Affiliations: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia.

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