• Users Online: 161
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 623-624

Mycosis fungoides: A rare scalp tumor


1 Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Nigeria
2 Department of Haematology and Blood Transfusion, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Nigeria

Date of Submission31-Jul-2021
Date of Decision24-Aug-2021
Date of Acceptance28-Aug-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Ajayi Adeleke Ibijola
Department of Haematology and Blood Transfusion, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_135_21

Rights and Permissions
  Abstract 


Cutaneous mycosis fungoides is a cutaneous T-cell lymphoma that can mimic a metastatic skull tumor. It responds satisfactorily to chemotherapy, and extensive surgical excision is not usually necessary. We managed a 55-year-old man who presented with a slow-growing scalp tumor which recurred with accelerated recurrence after radical excision. Histology showed cutaneous mycosis fungoides which resolved with chemotherapy. Mycosis fungoides can present as a slow-growing scalp tumor. Detailed clinical evaluation, neuroimaging, and trucut biopsy for histological diagnosis can prevent unnecessary aggressive radical tumor excision and its sequelae.

Keywords: Chemotherapy, cutaneous T-cell lymphoma, trucut biopsy


How to cite this article:
Okunlola AI, Ibijola AA. Mycosis fungoides: A rare scalp tumor. Niger J Med 2021;30:623-4

How to cite this URL:
Okunlola AI, Ibijola AA. Mycosis fungoides: A rare scalp tumor. Niger J Med [serial online] 2021 [cited 2021 Dec 8];30:623-4. Available from: http://www.njmonline.org/text.asp?2021/30/5/623/327954




  Introduction Top


Mycosis fungoides is a subtype of non-Hodgkin's T-cell lymphoma of the skin.[1] It is a misnomer as the name portrays a fungal infection but due to its mushroom-like appearance similar to fungal disease.[1] It is commoner in males in their 6th to 7th decades of life.[2] It is relatively common among Caucasians, rare in Asians, Africans, and Hispanics. The disease is a slow-growing skin tumor and can mimic metastatic skull lesions in the scalp.[3] Cranial computed tomography (CT) and brain magnetic resonance imaging are not usually sufficient for diagnosis, and histological diagnosis is the gold standard. Trucut biopsy of scalp tumor for histological diagnosis before extensive surgery may help avoid unnecessary surgery since this tumor responds satisfactorily to chemotherapy.[3],[4],[5] We present a middle-aged man who presented with a slow-growing scalp tumor who had cranial computed tomography and extensive scalp tumor excision before a histological diagnosis of cutaneous mycosis fungoides was made.


  Case Report Top


A 55-year-old man presented with a year history of slowly growing painless right frontal scalp swelling. There was no history of any other swelling. He has no history of systemic medical illness. Examination revealed a healthy looking middle-aged man. He was awake with normal mental status. He had no neurological deficits. There was a right frontal round scalp swelling measuring 5 cm × 6 cm in dimension. It was hard and immobile, attached to the overlying skin and underlying skull. There was a small fluctuant tender central portion. Examination of other systems was normal.

Diagnosis of right frontal osteoma with malignant transformation was made. Cranial CT scan showed a right frontal scalp hyperdense contrast-enhancing mass with bone density, attached to the skull. No intracranial lesion was observed. He had gross total excision of the mass and rotation flap cover of the defect. He had delayed healing of the scalp wound with associated wound edges nodule. He represented six-months postoperation with painless recurrent scalp mass measuring 13 cm × 15 cm in dimension with irregular edges. The previous histology report was reviewed and showed mycosis fungoides [Figure 1]. Full blood count and serum electrolytes and urea and creatinine were normal. Bone marrow aspiration cytology was normal.
Figure 1: Micrograph: Section showing effacement of the dermal architecture by proliferating sheets of malignant lymphoid cells. The cells have hyperchromatic nuclei and scanty cytoplasm. There is extensive necrosis

Click here to view


A definitive diagnosis of cutaneous T-cell lymphoma without bone marrow infiltration was made. He was commenced on chemotherapy–cyclophosphamide, vincristine, adriamycin, prednisolone, and allopurinol. He had four courses with complete tumor resolution.


  Discussion Top


Mycosis fungoides is a T-cell lymphoma with a satisfactory response to chemotherapy.[2],[5] These subtypes of lymphoma can mimic soft tissue or metastatic tumor, most especially when it occurs in certain body regions including the scalp.[1],[3] The index patient presented with a slow-growing scalp tumor and had rapidly progressive recurrence after extensive surgical excision. An initial trucut biopsy and histological diagnosis could have prevented this unnecessary surgery, financial burden of surgery, and wound complication and allow for early chemotherapeutic intervention.[4],[6]

Mycosis fungoides, though rare in Africans, should be on the list of differential diagnoses of scalp tumors and histological diagnosis before planned elective or definitive surgery is essential to properly and promptly initiate treatment protocol that will optimally benefit the patient.[7] The diagnosis of cutaneous T-cell lymphoma is frequently delayed because it can mimic other clinical entities such as fungal infection, dermatitis, and eczema in the early stage.[1] Our index patient presented late, and the scalp lesion was big and fixed to the underlying skull and overlying skin which suggested osteoma with malignant transformation, and he had radical surgical excision complicated by delayed wound healing and early recurrence.

Simple outpatient trucut biopsy and histological diagnosis could have been more beneficial since the cranial CT scan showed no intracranial extension.

Limitation

Clinical photographs and cranial CT images were not available.


  Conclusion Top


Mycosis fungoides can present as a slow-growing scalp tumor. Detailed clinical evaluation, neuroimaging, and trucut biopsy for histological diagnosis can prevent unnecessary aggressive radical tumor excision and its sequelae.

Patient consent statement

The patient gave consent for this publication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Girardi M, Heald PW, Wilson LD. The pathogenesis of mycosis fungoides. N Engl J Med 2004;350:1978-88.  Back to cited text no. 1
    
2.
Bagherani N, Smoller BR. An overview of cutaneous T cell lymphomas. F1000Res 2016;5:v1000-882.  Back to cited text no. 2
    
3.
Imran MB, Othman S, Shahid A. Unusual presentation of mycosis fungoides as a lump in the scalp. Singapore Med J 2011;52:e226-8.  Back to cited text no. 3
    
4.
Kossard S, White A, Killingsworth M. Basaloid folliculolymphoid hyperplasia with alopecia as an expression of mycosis fungoides (CTCL). J Cutan Pathol 1995;22:466-71.  Back to cited text no. 4
    
5.
Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome): Part II. Prognosis, management, and future directions. Jam Acad Dermatol 2014;70:223.e1-e17.  Back to cited text no. 5
    
6.
Gilliam AC, Lessin SR, Wilson DM, Salhany KE. Folliculotropic mycosis fungoides with large-cell transformation presenting as dissecting cellulitis of the scalp. J Cutan Pathol 1997;24:169-75.  Back to cited text no. 6
    
7.
Amin SM, Tan T, Guitart J, Colavincenzo M, Gerami P, Yazdan P. CD8+ mycosis fungoides clinically masquerading as alopecia areata. J Cutan Pathol 2016;43:1179-82.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed148    
    Printed6    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]