Large B-cell transformation of chronic lymphocytic leukemia presenting as a penile mass and skin lesion

Abstract

Hematol Oncol Stem Cell Ther 1(3) July 2008 hemoncstem.edmgr.com 199 A 77ayear old man was referred to our departa ment in January 2007 after developing a paina ful penile mass 2 months before. He had a history of chronic lymphocytic leukemia (CLL) for ten years. Two years before his referral he had received 12 courses of chlorambucil and prednisolone for the cona trol of resistant autoimmune hemolytic anemia. On physical examination there was splenomegaly (4 cm below the left costal margin) without palpable lymphadenopathy. Two violaceous nodular skin lesions with maximal diameters of 3 and 4 cm were evident in the left (Figure 1) and right forearm, respectively, as well as enlargement and hard infiltration of the base of the penis. Laboratory workaup revealed a positive dia rect antiaglobulin Coombs test (IgG) and the presence in the serum of IgGk monoclonal immunoglobulin. He had no anemia, thrombocytopenia or blood lymphocya tosis. A CT scan of the thorax and abdomen revealed a normal lung parenchyma and mediastinum, an absence of enlarged lymph nodes and only moderate splenoa megaly. The patient underwent sonographic examinaa tion of the penis. A large illadefined, heterogeneous, hypoechoic mass was shown infiltrating the corpora cavernosa. Color Doppler examination showed rich tumor vascularity. A pelvic MRI, using T2aweighted unenhanced and contrastaenhanced T1aweighted ima ages confirmed the presence of a mass infiltrating the corpora cavernosa and extending around the penile shaft with heterogeneous enhancement after contrast material administration (Figure 2). The mass invaded the corpus spongiusum, not extending to the urethra. Ultrasoundaguided penile biopsy and bilateral skin lesion biopsies were performed. Histopathologic exa amination revealed a diffuse infiltration by large Ba lympocytes (centroblast and immunoblast) (Figure 3). Tumor cells were CD45, CD20 and bcla6 positive and CD5, CD10, CD23, cyclin D3 and MUM1 negaa tive. A diagnosis of diffuse large Bacell lymphoma was Large B-cell transformation of chronic lymphocytic leukemia presenting as a penile mass and skin lesion