Folliculotropic mycosis fungoides with eosinophilia and CD30+ large-cell transformation: a case with a fatal outcome presenting with multifocal lesions and leonine facies.

Eosinophilia is recognized as a poor prognostic factor in patients with cutaneous T-cell lymphoma (CTCL). We report a case of folliculotropic mycosis fungoides (FMF) presenting with multiple ulcerative nodular lesions and persistent eosinophilia. Severe facial lesions resulted in a leonine appearance. On histopathological examination, nodular infiltration of large CD30+ large cells was seen. When the previous biopsy specimens were reviewed, marked folliculotropism with atypical lymphocytes was identified in previous specimens 20 years before the blastic transformation. CC chemokine receptor 3 was expressed in tumour cells, whereas CXC chemokine receptor 3 was negative. Expression of interleukin (IL)-5 was detected in a few mononuclear lymphoid cells. This case demonstrates that T helper (Th)2-polarized tumour cells may produce Th2 cytokines including IL-5, which suggests that cytokines and chemokines may contribute to persistent eosinophilia and to recruitment of eosinophils into tumour lesions in advanced FMF.