Cutaneous involvement in diffuse large B cell lymphoma at presentation: report of two rare cases and literature review

Sindhu Kilaru,Lalatendu Moharana,Soumya Surath Panda,Debahuti Mohapatra,Ghanashyam Biswas,Manas Baisakh,Suma Devaraj,Sourav Mishra,Spoorthy Kolluri

doi:10.1186/s43046-021-00085-1

Sindhu Kilaru, Lalatendu Moharana + Show 7 more

Open Access

https://doi.org/10.1186/s43046-021-00085-1

Copy DOI

Abstract

BackgroundDiffuse large B cell lymphoma (DLBCL) can occur at nodal and/or extra-nodal sites. After the gastrointestinal tract, cutaneous involvement predominates in extra-nodal DLBCL. Skin involvement at presentation can be in the form of plaques, papules, nodules or ulcers. Differentiating primary cutaneous DLBCL from systemic DLBCL with cutaneous involvement is important for appropriate patient management.Case presentationWe describe here, two interesting cases of skin involvement in DLBCL- one primary cutaneous DLBCL and the other, cutaneous involvement in systemic DLBCL with different clinico-pathological profiles. Though both cases had almost similar morphology of the skin lesions (ulcero-proliferative) at presentation, the disease was confined to the skin in the former, while the latter had involvement of lymph nodes and bone marrow.ConclusionsMeticulous clinical evaluation, appropriate histopathological and immunohistochemical workup helped in their diagnosis and correct classification of the disease status, guiding the further treatment decisions.

Highlights

ConclusionsMeticulous clinical evaluation, appropriate histopathological and immunohistochemical workup helped in their diagnosis and correct classification of the disease status, guiding the further treatment decisions
Diffuse large B cell lymphoma (DLBCL) can occur at nodal and/or extra-nodal sites
Depending on the primary site of involvement, DLBCL with cutaneous involvement can be divided into two groups—primary cutaneous DLBCL (PCDLBCL), which is confined to the skin, and DLBCL accompanied by secondary spread to the skin

Summary

Conclusions

Skin involvement at presentation in DLBCL could be either primary or secondary. Differentiating PCDLBCL from primary extra-nodal DLBCL presenting in the skin could be challenging at times. The first case was PCDLBCL-other, CD10+ GCB type and the second case was primary extra-nodal (skin) DLBCL with CD10−, and bcl-6, bcl-2, MUM 1 positivity. A meticulous evaluation for the search of extracutaneous disease is needed for correct classification of the disease, to initiate appropriate treatment regimens and importantly for patient prognostication and outcome measures

Background

Findings

Discussion