A 62-year-old man develops scaling and nonscaling patches

A 62-year-old man develops scaling and nonscaling patches, and plaques over his chest and back. They are itchy, but not painful. The rest of the examination is normal, except for lymphadenopathy. Examinations of the blood film and skin biopsy histology, both, reveal unusually large monocytoid cells. Which of the following is
the most likely diagnosis?

(A) leukemia
(B) visceral B-cell lymphoma
© primary cutaneous T-cell lymphoma
(D) viral infection (usually Epstein-Barr)
(E) paraneoplastic syndrome secondary to
lung cancer

solution:

These large cells are typical of Sézary syndrome, a leukemic form of cutaneus T-cell lymphoma (CTCL). This is frequently an early presentation of mycosis fungoides or CTCL. There may be a relationship to human T-cell
lymphotropic virus (HTLV) I and II, but it is not universal. CTCL is a malignancy of helper T cells (CD4+)