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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old woman with no past history of interest visited our dermatology clinic with multiple reddish lesions on both cheeks that had appeared a year earlier&#46; Physical examination revealed disperse telangiectases and several erythematous-pink papules in the malar regions&#59; one of the telangiectases was larger &#40;6&#160;&#215;&#160;5&#160;mm&#41; and it was decided to biopsy it &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Histopathology revealed a dense lymphocytic infiltrate located in the papillary and reticular dermis with a mixed nodular-diffuse growth pattern and cells with the appearance of centrocytes&#44; together with other&#44; slightly larger cells with the appearance of centroblasts &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immune staining was positive for CD10&#44; CD20&#44; CD79a&#44; Bcl-2&#44; and Bcl-6&#44; but negative for CD3 and cyclin D1 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Furthermore&#44; monoclonal rearrangement of the gene <span class="elsevierStyleItalic">IgH</span> was detected using PCR &#40;polymerase chain reaction&#41; and rearrangement of the gene <span class="elsevierStyleItalic">Bcl-2</span> was detected using FISH &#40;fluorescence in situ hybridization&#41;&#46; Flow cytometry was normal&#46; An initial staging was performed using computed tomography of the chest and abdomen&#44; and blood tests were carried out&#44; including lactate dehydrogenase&#44; but no evidence of systemic disease was found&#46; The findings were thus compatible with primary cutaneous follicle center B-cell lymphoma &#40;PCFCL&#41;&#44; which was confirmed following absence of systemic disease after 6 months&#46; A bone-marrow biopsy was not performed due to the painless course of this disease and to the results of the additional tests&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment consisted of intralesional rituximab &#40;anti-CD20 monoclonal antibody&#41; on 6&#160;occasions&#44; with a good response &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a>A and 3B&#41;&#46; The patient subsequently developed a new erythematous papule on the side of the nose &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a>C and 3D&#41;&#44; which&#44; together with the tendency of the patient&#8217;s skin toward redness and the presence of disperse telangiectases&#44; produced a a rosaceiform appearance&#46; Topical treatments such as metronidazole and ivermectin were therefore used&#46; Given the lack of response&#44; a new biopsy was taken&#44; which revealed histopathologic findings compatible with PCFCL&#46; The lesions were again treated with intralesional rituximab&#44; a malar lesion and a lesion on the internal occular surface were surgically excised&#44; and complete remission was observed&#46; A watch-and-wait approach was subsequently adopted despite the appearance of new lesions&#46; The patient is currently in joint follow-up with the dermatology and hematology departments&#44; with persistent multiple facial lesions and no extracutaneous involvement&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Primary cutaneous B-cell lymphoma &#40;PCBL&#41; is a B-cell lymphoma that affects the skin with no signs of extracutaneous disease on diagnosis or in the following 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to records&#44; the follicle center subtype &#40;PCFCL&#41; is the most common form of PCBL&#44; together with primary cutaneous marginal zone B-cell lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Both lymphomas present a painless chronic course&#44; which leads to an approximate 5-year survival rate of &#8805;95&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinically&#44; PCFCL presents firm&#44; asymptomatic papules&#44; plaques&#44; or tumors&#44; in isolation or in erythematous groups&#44; predominantly on the head&#44; neck&#44; and torso&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> According to the bibliography described&#44; B-cell lymphoproliferative disorder may mimic a rosacea&#44; although these are extremely rare cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> In 2012&#44; Barzilai et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> recorded 4 cases and in 2004&#44; Seward et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> contributed 1 further case&#44; all of which were PCFCL with rosacea or rhinophyma-like clinical lesions&#46; In 2011&#44; Massone et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> recorded a further 9 cases of PCFCL characterized by miliary or agminated lesions clinically compatible with rosacea&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis of PCBL is based on histologic&#44; immunophenotypic&#44; and genotypic findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> Classically&#44; the lack of expression of Bcl-2 and of the t&#40;14&#59;18&#41; chromosome translocation favors a diagnosis of PCFCL&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> Recent studies&#44; however&#44; show variable rates of positivity for expression of Bcl-2 &#40;0&#37;-86&#37;&#41; and t&#40;14&#59;18&#41; in PCFCL&#46; These include a retrospective comparative study<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> that reports positive expression of Bcl-2 in 69&#37; of cases of PCFCL and of t&#40;14&#59;18&#41; in 9&#46;1&#37; of cases&#46; Furthermore&#44; the authors suggest that strong immune staining of Bcl-2 may be a predictor of the systemic nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thus&#44; in light of these findings&#44; it is necessary to achieve a staging that excludes systemic disease&#44; and this should be maintained for at least 6 months to reach a definitive diagnosis of PCFCL&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; we lack randomized clinical trials that allow us to establish clear evidence-based recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In solitary or isolated lesion&#44; the use of radiation therapy is recommended&#59; otherwise&#44; in small&#44; clearly demarcated lesions&#44; surgical excision is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> More disperse lesions may be treated with radiation therapy&#59; nevertheless&#44; in light of the chronic&#44; painless course and the frequent recurrences of PCFCL&#44; a watch-and-wait approach may be adopted&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Intralesional rituximab is another option to consider&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> When the lesions are extensive&#44; systemic rituximab is the treatment of choice&#44; and chemotherapy &#40;R-COP&#44; R-CHOP&#41; should be reserved for exceptional cases of extracutaneous disease or lack of response to rituximab in patients with progressive disease&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary&#44; PCFCL may mimic a granulomatous rosacea&#46; The differential diagnosis of papulonodular eruptions on the face should therefore include B-cell lymphoproliferative disorders&#44; as well as adnexal tumors such as basal cell carcinoma&#44; trichoepithelioma&#44; and sebaceous hyperplasia&#44; and inflammatory dermatoses such as sarcoidosis and cutaneous lupus&#46; Knowledge of the clinical variability of PCFCL will facilitate early diagnosis and subsequent treatment&#44; where necessary&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Reddish Papules in the Center of the Face
Pápulas rojizas centrofaciales
J. Sarriugarte Aldecoa-Otaloraa,
Corresponding author
, J. Mitxelena Eceizaa, A. Córdoba Iturriagagoitiab, M.C. Viguria Alegríac
a Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Spain
b Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Spain
c Servicio de Hematología, Complejo Hospitalario de Navarra, Pamplona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old woman with no past history of interest visited our dermatology clinic with multiple reddish lesions on both cheeks that had appeared a year earlier&#46; Physical examination revealed disperse telangiectases and several erythematous-pink papules in the malar regions&#59; one of the telangiectases was larger &#40;6&#160;&#215;&#160;5&#160;mm&#41; and it was decided to biopsy it &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Histopathology revealed a dense lymphocytic infiltrate located in the papillary and reticular dermis with a mixed nodular-diffuse growth pattern and cells with the appearance of centrocytes&#44; together with other&#44; slightly larger cells with the appearance of centroblasts &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immune staining was positive for CD10&#44; CD20&#44; CD79a&#44; Bcl-2&#44; and Bcl-6&#44; but negative for CD3 and cyclin D1 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Furthermore&#44; monoclonal rearrangement of the gene <span class="elsevierStyleItalic">IgH</span> was detected using PCR &#40;polymerase chain reaction&#41; and rearrangement of the gene <span class="elsevierStyleItalic">Bcl-2</span> was detected using FISH &#40;fluorescence in situ hybridization&#41;&#46; Flow cytometry was normal&#46; An initial staging was performed using computed tomography of the chest and abdomen&#44; and blood tests were carried out&#44; including lactate dehydrogenase&#44; but no evidence of systemic disease was found&#46; The findings were thus compatible with primary cutaneous follicle center B-cell lymphoma &#40;PCFCL&#41;&#44; which was confirmed following absence of systemic disease after 6 months&#46; A bone-marrow biopsy was not performed due to the painless course of this disease and to the results of the additional tests&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment consisted of intralesional rituximab &#40;anti-CD20 monoclonal antibody&#41; on 6&#160;occasions&#44; with a good response &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a>A and 3B&#41;&#46; The patient subsequently developed a new erythematous papule on the side of the nose &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a>C and 3D&#41;&#44; which&#44; together with the tendency of the patient&#8217;s skin toward redness and the presence of disperse telangiectases&#44; produced a a rosaceiform appearance&#46; Topical treatments such as metronidazole and ivermectin were therefore used&#46; Given the lack of response&#44; a new biopsy was taken&#44; which revealed histopathologic findings compatible with PCFCL&#46; The lesions were again treated with intralesional rituximab&#44; a malar lesion and a lesion on the internal occular surface were surgically excised&#44; and complete remission was observed&#46; A watch-and-wait approach was subsequently adopted despite the appearance of new lesions&#46; The patient is currently in joint follow-up with the dermatology and hematology departments&#44; with persistent multiple facial lesions and no extracutaneous involvement&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Primary cutaneous B-cell lymphoma &#40;PCBL&#41; is a B-cell lymphoma that affects the skin with no signs of extracutaneous disease on diagnosis or in the following 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to records&#44; the follicle center subtype &#40;PCFCL&#41; is the most common form of PCBL&#44; together with primary cutaneous marginal zone B-cell lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Both lymphomas present a painless chronic course&#44; which leads to an approximate 5-year survival rate of &#8805;95&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinically&#44; PCFCL presents firm&#44; asymptomatic papules&#44; plaques&#44; or tumors&#44; in isolation or in erythematous groups&#44; predominantly on the head&#44; neck&#44; and torso&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> According to the bibliography described&#44; B-cell lymphoproliferative disorder may mimic a rosacea&#44; although these are extremely rare cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> In 2012&#44; Barzilai et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> recorded 4 cases and in 2004&#44; Seward et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> contributed 1 further case&#44; all of which were PCFCL with rosacea or rhinophyma-like clinical lesions&#46; In 2011&#44; Massone et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> recorded a further 9 cases of PCFCL characterized by miliary or agminated lesions clinically compatible with rosacea&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis of PCBL is based on histologic&#44; immunophenotypic&#44; and genotypic findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> Classically&#44; the lack of expression of Bcl-2 and of the t&#40;14&#59;18&#41; chromosome translocation favors a diagnosis of PCFCL&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> Recent studies&#44; however&#44; show variable rates of positivity for expression of Bcl-2 &#40;0&#37;-86&#37;&#41; and t&#40;14&#59;18&#41; in PCFCL&#46; These include a retrospective comparative study<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> that reports positive expression of Bcl-2 in 69&#37; of cases of PCFCL and of t&#40;14&#59;18&#41; in 9&#46;1&#37; of cases&#46; Furthermore&#44; the authors suggest that strong immune staining of Bcl-2 may be a predictor of the systemic nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thus&#44; in light of these findings&#44; it is necessary to achieve a staging that excludes systemic disease&#44; and this should be maintained for at least 6 months to reach a definitive diagnosis of PCFCL&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; we lack randomized clinical trials that allow us to establish clear evidence-based recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In solitary or isolated lesion&#44; the use of radiation therapy is recommended&#59; otherwise&#44; in small&#44; clearly demarcated lesions&#44; surgical excision is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> More disperse lesions may be treated with radiation therapy&#59; nevertheless&#44; in light of the chronic&#44; painless course and the frequent recurrences of PCFCL&#44; a watch-and-wait approach may be adopted&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Intralesional rituximab is another option to consider&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> When the lesions are extensive&#44; systemic rituximab is the treatment of choice&#44; and chemotherapy &#40;R-COP&#44; R-CHOP&#41; should be reserved for exceptional cases of extracutaneous disease or lack of response to rituximab in patients with progressive disease&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary&#44; PCFCL may mimic a granulomatous rosacea&#46; The differential diagnosis of papulonodular eruptions on the face should therefore include B-cell lymphoproliferative disorders&#44; as well as adnexal tumors such as basal cell carcinoma&#44; trichoepithelioma&#44; and sebaceous hyperplasia&#44; and inflammatory dermatoses such as sarcoidosis and cutaneous lupus&#46; Knowledge of the clinical variability of PCFCL will facilitate early diagnosis and subsequent treatment&#44; where necessary&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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