Subcutaneous Panniculitis-Like T-Cell Lymphoma

Subcutaneous panniculitis-like T-cell lymphoma is a rare cutaneous T-cell lymphoma (SPTCL) that is characterized by subcutaneous nodules and plaques. The similarity of presentation to that of panniculitis is the reason for the long name. The disease most commonly involves the legs, but can also affect the trunk. It can be differentiated from the cutaneous T-cell lymphomas (e.g., mycosis fungoides and Sézary syndrome) by the fact that the former are cutaneous, and SPTCL is subcutaneous.

References

Levine BD, Seeger LL, James AW, Motamedi K. Subcutaneous panniculitis-like T-cell lymphoma: MRI features and literature review. Skeletal Radiol. 2014 Sep;43(9):1307-11.

Costochondritis

Costochondritis, as its implies, is a nonspecific term for inflammation of the costal cartilage. The problem with this definition is that it implies a non-specific process, where inflammation can be caused by any number of pathological processes, including trauma, infection, or radiation.

The clinical entity of costochondritis, on the other hand, has specific features:

• Self-limited
• Usually multiple affected levels
• Can occur at the costochondral junction or at the chondrosternal joints
• No swelling or induration on physical examination
• Pain that is reproduced by palpation and may radiate on the chest wall

This definition differentiates costochondritis from the much rarer Tietze syndrome (TS). In TS, the inflammatory process causes visible enlargement of the costochondral junction(s) and is most commonly isolated to a single rib (usually the 2nd, but can also involve the 3rd rib). TS can be caused by infectious, rheumatologic, and neoplastic processes. The infection is usually associated with trauma (e.g., stab wounds, iatrogenic) or with intravenous drug use.

Costochondritis is relatively common, and can be seen is as many as 14% of adolescents and 13 to 36% of adults with chest pain.

References

Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 15;80(6):617-20.