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An atypical presentation of cutaneous diffuse large B-cell lymphoma, leg type

Selma El Kadiri, Zakia Douhi, Rhizlane Chaoui, Sara Elloudi, Hanane Baybay, Fatima-Zahra Mernissi

Department of Dermatology, CHU Hassan II, Fez, Morocco

Corresponding author: Dr. Selma El Kadiri

Submission: 15.03.2020; Acceptance: 06.04.2020

DOI: 10.7241/ourd.2020e.49

Cite this article: El Kadiri S, Douhi Z, Chaoui R, Elloudi S, Baybay H, Mernissi F-Z. An atypical presentation of cutaneous diff use large B-cell lymphoma, leg type. Our Dermatol Online. 2020;11(e):e49.1.

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A 45 year-old man presented with multiple, erythematous and painful tumors on the lower leg 7 months ago. The lesions were ulcerated to the epidermis and clinical lymphadenopathy were noticed. The tumors were well limited with surelevated borders and grouped on the lower leg (Fig. 1). The diagnosis of gangrenosum pyoderma was suspected clinically. A histological examination revealed a diffuse proliferation of large lymphocytes in the deep dermis with atypical mitosis. Immunohistochemistry was positive for CD20, Bcl-2, Bcl-6, and KI-67.The diagnosis of a cutaneous diffuse large B-cell lymphoma, leg type. Laboratory exams especially LDH, b microglobuline and a body scan were normal. Unfortunately the follow-up of the patient was lost.

Figure 1: Multiple tumors on the lower leg.                                                             

Primary cutaneous lymphoma B type leg represent only 5% of cutaneous lymphomas [1]. The particularity of our observation is the young age of the patient and atypical presentation of lesions. Multiple observations suggest that the localization in the legs explained by chronic veinous insuffisancy which facilitates the apparition of a clone by diminution of local immunity with antigenic stimulation [2]. Here we report an atypical presentation of lymphoma type leg mimicking a pioderma gangrenosum.

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The examination of the patient was conducted according to the Declaration of Helsinki principles.

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

REFERENCES

1. Grange F, Beylot-Barry M, Courville P, Maubec E, Bagot M, Vergier B, et al. Primary cutaneous diffuse large B-cell lymphoma, leg type:clinicopathologic features and prognostic analysis in 60 cases. Arch Dermatol. 2007;14:1144-50.

2. Cendras J, Sparsa A, Bedane C, Delage M, Touati M, Bonnetblanc JM. Lymphome B primitif àgrandes cellules cd20-, cd79a+apparu sur un ulcère veineux chronique de jambe. Ann Dermatol Venereol. 2007;134:357-61.

Notes

Source of Support: Nil.

Conflict of Interest: None declared.

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