Case and Research Letters
Diffuse Systemic Large B-Cell Lymphoma With Secondary Skin Involvement
Linfoma B difuso de células grandes sistémico con afectación cutánea secundaria
C. Lloret-Ruiz
, P. Molés-Poveda, N. Barrado-Solís, E. Gimeno-Carpio
Corresponding author
Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain
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Lloret-Ruiz, P. Molés-Poveda, N. Barrado-Solís, E. Gimeno-Carpio" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Lloret-Ruiz" "email" => array:1 [ 0 => "clloretruiz@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Molés-Poveda" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Barrado-Solís" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Gimeno-Carpio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma B difuso de células grandes sistémico con afectación cutánea secundaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1682 "Tamanyo" => 314385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated erythematous-violaceous plaque.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diffuse large B-cell lymphoma (DLBCL) is the most common type of systemic lymphoma and accounts for 40% of all new cases of this disease. Prognosis has improved considerably since the introduction of rituximab, which combined with chemotherapy is associated with a cure rate of up to 50%<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>; R-CHOP is the regimen of choice. Secondary cutaneous involvement is uncommon in DLBCL, although it has been observed in up to 20% of cases in some series.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 81-year-old man in good health who presented with an indurated, erythematous-violaceous plaque-like lesion with a diameter of 7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm on the right leg (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The plaque had appeared 3 weeks earlier.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy was performed to investigate the suspected diagnosis of primary cutaneous lymphoma, with results showing a diffuse, dense infiltration of large, highly pleomorphic atypical basophilic cells in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemical stains were positive for B-cell markers (CD20, CD79a), negative for T-cell markers (CD3, CD5), and strongly positive for Bcl-2. Less intense staining was observed for Bcl-6 and MUM-1, and the results were negative for CD10 and CD30 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). Ki-67 staining showed high proliferative activity (90%). Fluorescent in situ hybridization was negative for <span class="elsevierStyleItalic">Bcl-2</span> rearrangement with the t(14;18) translocation.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A computed tomography staging study revealed multiple enlarged infradiaphragmatic and supradiaphragmatic lymph nodes and a tumor measuring 6<span class="elsevierStyleHsp" style=""></span>cm on the left kidney. Bone marrow biopsy showed an infiltration of small cells with positive B-cell markers. Unlike the skin biopsy, the bone marrow biopsy showed CD5 expression and an absence of Bcl-6 and MUM-1 expression, leading to a diagnosis of chronic lymphocytic leukemia. The definitive diagnosis was thus systemic DLBCL with secondary cutaneous involvement due to a previous unknown transformation of chronic lymphocytic leukemia (Richter syndrome or transformation). The patient was treated with R-CHOP, which initially resulted in a reduction in the size of the skin tumor and the lymph nodes. However, he died 4 months later due to neutropenic sepsis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">DLBCL is a heterogeneous entity with multiple clinical and pathologic variants. It is most common in individuals aged over 60 years. It is also the most common type of lymphoma in patients with human immunodeficiency virus infection. Because of its high proliferative activity, it is sometimes diagnosed earlier than other more indolent lymphomas. Immunophenotypically, all DLBCLs express B-cell markers, and other markers are expressed in a variable proportion of tumors (Bcl-6 in 60%-90%, MUM-1 in 35%-65%, and Bcl-2 in 50%). Although Bcl-2 is expressed in over 60% of tumors, <span class="elsevierStyleItalic">Bcl-2</span> rearrangement is observed in under 20% of cases, suggesting the existence of other genetic pathways for the expression of this protein. There has also been a description of a double-hit variant involving both <span class="elsevierStyleItalic">Bcl-2</span> and <span class="elsevierStyleItalic">Myc</span> rearrangement associated with worse prognosis and a greater tendency for secondary cutaneous involvement.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary cutaneous variant of DLBCL, primary cutaneous diffuse large B-cell lymphoma (PCDLBCL), leg type, is one of the 3 most common types of primary cutaneous B-cell lymphomas, together with primary cutaneous follicle center lymphoma and marginal zone B-cell lymphoma. PCDLBCL, leg-type presents as solitary or multiple violaceous plaques that typically occur on the legs of elderly patients. It is by far the primary cutaneous B-cell lymphoma with the worst prognosis, with a 5-year survival of 50%. It is therefore essential to initiate treatment with multi-agent chemotherapy and rituximab as early as possible.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Because the immunohistochemical markers are the same for PCDLBCL, leg type and its systemic variant, DLBCL, according to the current WHO-EORTC criteria,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> definitive diagnosis should be based on the presence or absence of extracutaneous disease at diagnosis. Testicular B-cell lymphoma can also affect the skin and its pathologic and immunophenotypic characteristics are indistinguishable from those of PCDLBCL, leg type; routine testicular examination is therefore recommended in appropriate cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We have reported a case of systemic DLBCL diagnosed following the detection of a cutaneous lesion without other signs or symptoms. One particularly interesting aspect of this case was the presence of a solitary lesion that clinically resembled a primary cutaneous lymphoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lloret-Ruiz C, Molés-Poveda P, Barrado-Solís N, Gimeno-Carpio E. Linfoma B difuso de células grandes sistémico con afectación cutánea secundaria. Actas Dermosifiliogr. 2015;106:685-687.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1682 "Tamanyo" => 314385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated erythematous-violaceous plaque.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1263 "Ancho" => 1685 "Tamanyo" => 473772 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dense dermal infiltration of pleomorphic, atypical lymphocytes.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 970 "Ancho" => 2589 "Tamanyo" => 468966 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive immunohistochemical staining for CD20 (A) and Bcl-2 (B) (original magnification ×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aggressive Lymphomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Lenz" 1 => "L.M. Staudt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra0807082" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "362" "paginaInicial" => "1417" "paginaFinal" => "1429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20393178" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous diffuse large B-cell lymphoma, leg type: Clinicopathologic features and prognostic analysis in 60 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Grange" 1 => "M. Beylot-Barry" 2 => "P. Courville" 3 => "E. Maubec" 4 => "M. Bagot" 5 => "B. Vergier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.9.1144" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "1144" "paginaFinal" => "1150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17875875" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous double-hit B-cell lymphoma: An aggressive form of B-cell lymphoma with a propensity for cutaneous dissemination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.M. Magro" 1 => "X. Wang" 2 => "S. Subramaniyam" 3 => "N. Darras" 4 => "S. Mathew" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31829beaa7" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "303" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23907319" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous B-cell lymphomas: Part I. Clinical features, diagnosis, and classification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. Suárez" 1 => "M. Pulitzer" 2 => "S. Horwitz" 3 => "M. Pulitzer" 4 => "S. Horwitz" 5 => "A. Moskowitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2013.06.012" "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2013" "volumen" => "69" "paginaInicial" => "329.e1-13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23957984" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO-EORTC classification for cutaneous lymphomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Willemze" 1 => "E.S. Jaffe" 2 => "G. Burg" 3 => "L. Cerroni" 4 => "E. Berti" 5 => "S.H. Swerdlow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2004-09-3502" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2005" "volumen" => "105" "paginaInicial" => "3768" "paginaFinal" => "3785" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692063" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous diffuse large B-cell lymphoma, leg type and secondary cutaneous involvement by testicular B-cell lymphoma share identical clinicopathological and immunophenotypical features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Muniesa" 1 => "R.M. Pujol" 2 => "M.T. Estrach" 3 => "F. Gallardo" 4 => "M.P. García-Muret" 5 => "J. Climent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2011.03.031" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "66" "paginaInicial" => "650" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21816504" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000008/v1_201510011018/S1578219015002097/v1_201510011018/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000008/v1_201510011018/S1578219015002097/v1_201510011018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002097?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 7 | 13 |
| 2024 October | 93 | 44 | 137 |
| 2024 September | 76 | 54 | 130 |
| 2024 August | 111 | 63 | 174 |
| 2024 July | 102 | 36 | 138 |
| 2024 June | 121 | 41 | 162 |
| 2024 May | 120 | 33 | 153 |
| 2024 April | 96 | 19 | 115 |
| 2024 March | 89 | 36 | 125 |
| 2024 February | 93 | 31 | 124 |
| 2024 January | 75 | 34 | 109 |
| 2023 December | 79 | 23 | 102 |
| 2023 November | 101 | 29 | 130 |
| 2023 October | 72 | 19 | 91 |
| 2023 September | 89 | 34 | 123 |
| 2023 August | 62 | 16 | 78 |
| 2023 July | 85 | 39 | 124 |
| 2023 June | 84 | 24 | 108 |
| 2023 May | 123 | 24 | 147 |
| 2023 April | 85 | 25 | 110 |
| 2023 March | 90 | 22 | 112 |
| 2023 February | 86 | 24 | 110 |
| 2023 January | 67 | 26 | 93 |
| 2022 December | 88 | 42 | 130 |
| 2022 November | 51 | 25 | 76 |
| 2022 October | 30 | 36 | 66 |
| 2022 September | 35 | 46 | 81 |
| 2022 August | 36 | 30 | 66 |
| 2022 July | 22 | 33 | 55 |
| 2022 June | 22 | 22 | 44 |
| 2022 May | 59 | 42 | 101 |
| 2022 April | 82 | 42 | 124 |
| 2022 March | 76 | 52 | 128 |
| 2022 February | 77 | 34 | 111 |
| 2022 January | 85 | 54 | 139 |
| 2021 December | 47 | 41 | 88 |
| 2021 November | 52 | 52 | 104 |
| 2021 October | 49 | 47 | 96 |
| 2021 September | 33 | 41 | 74 |
| 2021 August | 77 | 39 | 116 |
| 2021 July | 69 | 41 | 110 |
| 2021 June | 61 | 43 | 104 |
| 2021 May | 46 | 29 | 75 |
| 2021 April | 82 | 45 | 127 |
| 2021 March | 77 | 28 | 105 |
| 2021 February | 62 | 36 | 98 |
| 2021 January | 49 | 28 | 77 |
| 2020 December | 36 | 27 | 63 |
| 2020 November | 22 | 21 | 43 |
| 2020 October | 22 | 15 | 37 |
| 2020 September | 33 | 19 | 52 |
| 2020 August | 24 | 22 | 46 |
| 2020 July | 21 | 12 | 33 |
| 2020 June | 33 | 37 | 70 |
| 2020 May | 21 | 10 | 31 |
| 2020 April | 37 | 17 | 54 |
| 2020 March | 29 | 17 | 46 |
| 2020 February | 10 | 1 | 11 |
| 2020 January | 0 | 2 | 2 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 1 | 0 | 1 |
| 2019 September | 8 | 3 | 11 |
| 2019 August | 4 | 1 | 5 |
| 2019 July | 4 | 4 | 8 |
| 2019 June | 4 | 15 | 19 |
| 2019 May | 5 | 44 | 49 |
| 2019 April | 3 | 1 | 4 |
| 2019 March | 2 | 3 | 5 |
| 2019 February | 6 | 0 | 6 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 8 | 1 | 9 |
| 2018 August | 0 | 11 | 11 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 3 | 3 |
| 2018 May | 0 | 10 | 10 |
| 2018 April | 0 | 9 | 9 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 49 | 11 | 60 |
| 2018 January | 68 | 10 | 78 |
| 2017 December | 48 | 10 | 58 |
| 2017 November | 23 | 11 | 34 |
| 2017 October | 35 | 7 | 42 |
| 2017 September | 23 | 15 | 38 |
| 2017 August | 33 | 4 | 37 |
| 2017 July | 26 | 12 | 38 |
| 2017 June | 34 | 21 | 55 |
| 2017 May | 39 | 21 | 60 |
| 2017 April | 15 | 14 | 29 |
| 2017 March | 8 | 7 | 15 |
| 2017 February | 19 | 6 | 25 |
| 2017 January | 15 | 14 | 29 |
| 2016 December | 28 | 16 | 44 |
| 2016 November | 36 | 27 | 63 |
| 2016 October | 26 | 21 | 47 |
| 2016 September | 0 | 7 | 7 |
| 2016 August | 0 | 1 | 1 |
| 2016 July | 0 | 2 | 2 |
| 2016 June | 3 | 6 | 9 |
| 2016 May | 2 | 5 | 7 |
| 2016 April | 6 | 3 | 9 |
| 2016 February | 0 | 1 | 1 |
| 2016 January | 0 | 3 | 3 |
| 2015 November | 0 | 1 | 1 |
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