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Weekly Chest CasesArchive of Old Cases

Case No : 748 Date 2012-02-27

  • Courtesy of Jung Won Moon, MD. Ho Yun Lee, MD. / Samsung Medical Center
  • Age/Sex 58 / M
  • Chief Complaintpurple-colored, elevated skin lesions on back
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Cutaneous diffuse Large B-cell lymphoma
Radiologic Findings
Chest CT images show multifocal subcutaneous soft tissue lesions with reticular margins and enhancement in left upper back. Enlarged right supraclavicular lymph nodes are also noted. These lesions and LNs show increased FDG uptake.
Brief Review
Primary cutaneous B-cell lymphomas (PCBCLs) were defined as B-cell lymphomas manifesting on the skin without evidence of extracutaneous disease. PCBCLs are much less common than primary cutaneous T-cell lymphomas (PCTCLs) and represent approximately 20% to 25% of all primary cutaneous lymphomas. For many years, there has been confusion regarding the terminology and classification of PCBCL, which may have come to an end with the publication of the new World Health Organization-European Organization for Research and Treatment of Cancer(WHO-EORTC) classification for PCBCL. This classification distinguishes 3 main types of PCBCL: primary cutaneous marginal zone B-cell lymphoma (PCMZL), primary cutaneous follicle center lymphoma (PCFCL), and primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT).
PCMZL is presented as solitary or multiple papules, plaques, or nodules preferentially localized on the extremities, and sometimes associated with Borrelia burgdorferi infection. It shows frequent cutaneous relapses and rare extracutaneous dissemination. Histopathology reveals patchy or diffuse infiltrates composed of small B cells, including marginal zone (centrocyte-like) cells, lymphoplasmacytoid cells, and plasma cells. Immunophenotype incudes monotypic cIg, CD79a+, Bcl-2+, CD5-, cyclin D1-, Bcl-6-, CD10-, MUM-1+ (on plasma cells). Five-year survival is more than 95%.
PCFCL shows solitary or grouped tumors presenting on the head or on the trunk, and cutaneous relapses occur in 20%. Extracutaneous dissemination is found in 5% to 10%. Histopathology of PCFCL reveals follicular, follicular and diffuse, or diffuse infiltrates composed of neoplastic follicle center cells, usually a mixture of centrocytes and variable numbers of centroblasts. Monotypic sIg or absence of sIg, CD20+, CD79a+, Bcl-6+, Bcl-2-, MUM-1-, CD10짹, FOXP1- (짹) are possible as immunophenotype. Five-year survival is 95%.
PCLBCL is presented as solitary or multiple tumors presenting mainly on the leg(s) and rarely at other sites. It shows frequent relapses and extracutaneous dissemination. Diffuse infiltrates with a predominance or confluent sheets of of centroblasts and immunoblasts Immunophenotype are seen on histopathologic examination, and monotypic sIg and/or cIg, CD20+, CD79a+, Bcl-6+(-), CD10-, Bcl-2+, MUM-1+, FOXP1+ are detected as immunophenotypes.
This case is primary cutaneous diffuse large B-cell lymphoma, involving mainly trunk and right arm. No involvement of legs was detected, and the patient was considered as cutaneous diffuse large B-cell lymphoma, not otherwise specified. He is going on the chemotherapy with regimen of R-CHOP.
References
Nancy J. Senff et al, European Organization for Research and Treatment of Cancer and International Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous B-cell lymphomas. Blood, 1 Sep 2008, Vol 112, Number 5, 1600-1609.
Keywords
chest wall, lymphoproliferative disease,

No. of Applicants : 101

▶ Correct Answer : 38/101,  37.6%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Scans world , India Philson Mukkada
  • - GwangmyeongInHospital , Korea (South) Ju Won Lee
  • - UWO , Canada S Lee
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - fmmc , India subas kandimalla
  • - NATIONAL GUARD HEALTH SERVICES , Saudi Arabia MOHAMED AHAMED
  • - , Canada Andrea Ojanguren
  • - CHRU lille , France manuel toledano
  • - HIA Legouest - METZ , France Alban Gervaise
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Shree Diagnostics , India amol jagdale
  • - Chonnam national univ. hospital , Korea (South) Choi Gi
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Korea university , Korea (South) SUMIN HA
  • - Asan medical center , Korea (South) sang young oh
  • - Saint Malo , France jean-baptiste Noel
  • - Saga University , Japan Ryoko Egashira
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - korea university , Korea (South) Hyelarn Lee
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - KUMC ansan , Korea (South) kihwan kim
  • - CH lyon Sud , France matthieu ROUSSET
  • - Azienda Ospedaliera San Gerardo , Italy Gabriele DAndrea
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Private sector , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 32/101,  31.7%
  • - KING ABDULAZIZ SPECIALIST HOSPITAL , Saudi Arabia Elbagir Nasser
  • - SNUH , Korea (South) Euijin Hwang
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - radiologist, aditya imaging centre , India vivek patel
  • - Montreal , Canada D J
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Goa Medical College , India Paresh Desai
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Travancore Medical College , India Chary D
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Iwate Medical University , Japan Akio Akahane
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - IRSA , France, Metropolitan BIGOT
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - CHRU Lille , France Paul Lebert
  • - Okayama University Hospital , Japan Yoshihisa Masaoka
  • - NASA SCANS , India RAKESH BHATIA
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - CLCC , France nicolas gautier
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - XiangYa hospital , China Xia Yu
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - shengjing hospital china medical university , China yue yong
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