FOLLICULOTROPIC MYCOSIS-FUNGOIDES WITH LARGE-CELL TRANSFORMATION PRESENTING AS DISSECTING CELLULITIS OF THE SCALP

Follicular mycosis fungoides (MF) is a rare variant of cutaneous T-cel l lymphoma (CTCL) in which malignant lymphocytes preferentially infilt rate hair follicles, This report describes a patient with follicular m ycosis fungoides presenting in a manner similar to dissecting cellulit is of the scalp with nonhealing, draining nodular lesions. Follicular mucinosis associated with folliculotropic mycosis fungoides resulted i n follicular disruption and deep dissecting cellulitis, Large-cell tra nsformation of CTCL was present in the initial diagnostic scalp and ax illary lymph node specimens, The patient died from progressive CTCL 9 months following initial diagnosis despite electron beam radiation, to pical mechlorethamine, interferon-a, and systemic chemotherapy. This c ase indicates that large-cell transformation of folliculotropic mycosi s fungoides is an aggressive form of CTCL, and that folliculotropic my cosis fungoides can give rise to lesions which resemble dissecting cel lulitis of the scalp. Upregulation of intercellular adhesion molecule- 1 (ICAM-1) on follicular epithelium adjacent to lymphocyte function-as sociated antigen-1 (LFA-1)-positive folliculotropic lymphoma cells in this report provides insight into lymphocyte homing mechanisms in foll iculotropic MF.