The emergence of Sézary cells during the treatment of cutaneous T-cell lymphoma.

A 52-year-old man with cutaneous T-cell lymphoma presented with Sézary syndrome-like features including exfoliative erythroderma, lymphadenopathy and leukaemic change without the presence of Sézary cells. Southern blot hybridization analysis revealed T-cell receptor beta-chain gene rearrangements, both in the peripheral blood and in the lymph node. Atypical large cells with convoluted nuclei (Sézary-like cells) first appeared during combined chemotherapy. Although Sézary syndrome is characterized by its particular manifestations and the presence of Sézary cells in the peripheral blood, the clinical significance of Sézary cells has been questioned. It still needs to be decided whether or not the Sézary cell is malignant.