Subcutaneous Panniculitis-like T-cell Non-Hodgkin Lymphoma Associated with Cushing Syndrome: An Introspection

Authors

  • Maria Palfi “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca
  • Alexandra Zirbo Fourth-year medical student, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Cristina Simian Fourth-year medical student, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Dávid Kegyes Sixth-year medical student, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Anamaria Bancoș MD, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania, Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania
  • Ciprian Tomuleasa MD, Phd, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania, Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania

DOI:

https://doi.org/10.5195/ijms.2025.4087

Keywords:

Non-Hodgkin Lymphoma, Cushing's Syndrome, RCHOP regimen

Abstract

Background: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) accounts for less than 1% of non-Hodgkin lymphoma cases and is characterized by malignant lymphocyte infiltration into adipose tissues. The term “panniculitis-like T -cells” refers to the histological similarity of the lymphoma cells to the T-cells found in chronic or granulomatous panniculitis. This type of lymphoma is responsible for an ectopic ACTH secretion which leads to excessive cortisol secretion causing Cushing syndrome.   

Case: A 45-year-old patient diagnosed with SPTCL in 2022 underwent six cycles of cyclophosphamide, epirubicin, vincristine, and prednisone (CHOP regimen). Due to iatrogenic Cushing syndrome, CHOP was discontinued, and two cycles of rituximab-ifosphamide-carboplatin-etoposide (R-ICE) were administered. In 2023, the patient presented with scleral jaundice and dark urine. Laboratory findings revealed a total bilirubin of 11.2 mg/dL, leukopenia, thrombocytopenia, hyperfibrinogenemia, and elevated D-dimers. A CT scan showed hepatic and iliopsoas muscle lesions, indicating systemic dissemination and relapse of the lymphoma.

Conclusion: Corticosteroid-based regimens are standard treatment options for SPTCL. However, paraneoplastic syndromes such as ectopic ACTH secretion by malignant cells may lead to excessive cortisol levels, exacerbated by corticosteroids. Due to iatrogenic Cushing syndrome induced by the first-line therapy and relapse following second-line options, off-label venetoclax, an apoptosis inducer, was initiated in combination with ropeginterferon alfa-2b. The patient achieved complete remission. No SPTCL cases treated with venetoclax have been published in the literature. We report high efficacy of off-label venetoclax in a relapsed SPTCL with no other available therapeutic option.

 

 

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Published

2025-12-31

How to Cite

Palfi, M., Zirbo, A., Simian, C., Kegyes, D., Bancoș, A., & Tomuleasa, C. (2025). Subcutaneous Panniculitis-like T-cell Non-Hodgkin Lymphoma Associated with Cushing Syndrome: An Introspection . International Journal of Medical Students, 13, S206. https://doi.org/10.5195/ijms.2025.4087

Issue

Vol 13. (2025): Supplement 1

Section

Abstracts of the WCMSR

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Copyright (c) 2025 Maria Palfi, Alexandra Zirbo, Cristina Simian, Dávid Kegyes, Anamaria Bancoș, Ciprian Tomuleasa

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