Home > Cases > Main Index > Case 067 | Skeletal Index  

SRS-X The SRS Educational Resource

Case 067

Cutaneous T cell lymphoma

A 21 year old with a skin lesion

This 21 year old presented with a localised area of reddened skin over the left shoulder. This had been present for several weeks.

An MRI of the shoulder was performed to assess the lesion further. Example images are shown from the following sequences:

1. Axial T1 and T2 STIR (fat suppression)
2. Axial T1 pre and post gadolinium
3. Coronal T2 STIR

Findings

The superficial bright nodule is an oil capsule used as a skin marker (best seen on the T1 images).

There is a soft tissue lesion lying within the subcutaneous fat overlying the deltoid muscle. No muscle involvement is seen. This lesion enhance brightly following contrast.

On T2 weighted STIR images it appears bright against the suppressed signal from subcutaneous fat, indicating increased water content.

Note also the enhancing masses in the axilla, which are bright on the T2 STIR images, indicating axillary node involvement. Some smaller subcutaneous nodules were also seen separate from the primary lesion (on images not shown).

Diagnosis

Cutaneous T cell lymphoma with axillary node involvement

Discussion

An enhancing subcutaneous lesion in isolation could be due to a number of causes, such as a benign haemangioma. Indeed this was initially considered the likely cause. However the presence of spread to axillary nodes suggests a more malignant process. The MRI is not diagnostic; the diagnosis was made on biopsy. CT confirmed the axillary lymphadenopathy but showed no evidence of disease in the chest, abdomen or pelvis.

Main Index  |   Previous Case

Skeletal Index  |   Previous Case

Main Index as Unknowns

Skeletal Index as Unknowns