Diffuse primary cutaneous large B- cell lymphoma, leg type: case report

Abstract

Abstract: 

Introduction: Diffuse Cutaneous Large B- cell lymphoma is an aggressive type of non-Hodgkin B lymphoma, affecting the skin of the legs and less frequently other skin areas. It occurs in elderly patients, frequently in women, as single or multiple plaques, papules and nodules, red or bluish in color, on one or both legs. It consists of a proliferation of large B-cells (centroblasts and immunoblasts), arranged diffusely or confluently nodular, occupying the reticular dermis and infiltrating the underlying adipose tissue. Furthermore, these cells are frequently found in and around dilated dermal and subcutaneous vessels. Its immunophenotype is: CD20+, CD79+, Bcl2+, MUM-1+, CD10-, Bcl6-.

The prognosis is poor and the treatment consists of local radiotherapy and polychemotherapy in patients with systemic extension.

The objective is to report an infrequent case of lymphoma, the diagnostic approach and proposal of differential diagnosis.

Case presentation: 80 year old female who consults for skin lesions of leg with a 20 days evolution. Biopsy was indicated: skin lozenge 12mm the widest part and 4 mm thick. The epidermis was smooth, brownish in color, dome-shaped and soft in consistency. The sample was processed with the usual technique for stainning with hematoxylin/eosin.

Histologically, a neoplasic proliferation of large cell lymphoid lineage was observed. The majority corresponded to centrocytes, centroblasts and immunoblasts, mitosis was frequent. Neoplasic cells were distributed in a diffuse growth pattern along the dermis surrounding the annexes and blood vessels. The study was complemented with immunohistochemistry: AE1AE3-, CD20+, MUM-1+, Ki67>90%.

Conclusion: these diffuse cutaneous lymphomas are infrequent and it is necessary to differentiate them from other cutaneous lymphomas, such as, follicular center B, of different prognosis. They appear with typical clinical symptoms that should not go unnoticed since, with the histological and immunohistochemical study, a quick diagnosis is reached as the proper treatment must be started inmediatly to improve survival of patients.