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DERM DIAGNOSIS.

This 43-year-old woman presented with a 2-month history of progressive facial erythema, edema, and induration. The medical history was remarkable for goides, for which she had been treated with, PUVA and interferon.

SNOWBIRD, UTAH -- Transformation of mycosis fungoides to large cell lymphoma occurs in about 30% of patients with stage IIB-IV disease. Such patients have a poor prognosis, Dr. Scott R. Florell said at a seminar on clinical dermatology sponsored by Westwood-Squibb.

A biopsy from the woman's face showed periadnexal infiltrates of large lymphoid cells that were CD3 positive and CD7 and CD30 negative T-cell gene rearrangement studies confirmed a monoclonal population and showed an identical band pattern to that seen with her initial diagnosis of mycosis fungoides, said Dr. Florell, a dermatologist at the University of Utah, Salt Lake City.

The patient was treated with CHOP chemo therapy (cyclophosphamide, doxorubicin, vincristine, prednisone), and she had a dramatic initial response.

Several weeks later, however, she again presented with facial erythema, edema and induration, as well as lymphadenopathy and organomegaly. The white blood cell count was 70,000 per [micro]L and the lactic dehydrogenase level was 12 000 U/L.

Despite the aggressive, chemotherapy regimen the woman developed pulmonary infiltrates and died about 4 months after transformation of her mycosis fungoides to large cell lymphoma.

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Article Details
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Author:Donohue, Maureen
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 1, 2001
Words:215
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