Cases and Research Letters
Cutaneous B-cell Lymphoma: The Importance of Clinicopathologic Correlation
Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica
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Morell, J. Bassas-Vila, J.L. Mate, I. Bielsa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Morell" "email" => array:1 [ 0 => "laiamorell@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Bassas-Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.L." "apellidos" => "Mate" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Bielsa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1190 "Ancho" => 1579 "Tamanyo" => 523173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed almost equal numbers of B and T cells; the T cells were predominantly CD4<span class="elsevierStyleSup">+</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cutaneous follicle center lymphoma (FLC) is defined as a malignant proliferation of germinal center cells confined to the skin. It has 3 growth patterns: follicular, diffuse, and mixed. It usually presents clinically as erythematous papules, plaques, and tumors, generally without ulceration, that most often affect the head, the neck, and the trunk. There is, however, a less common variant known as reticulohistiocytoma of the back or Crosti lymphoma that affects the back and consists of plaques and tumors surrounded by macules and papules that extend outward from the tumor.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case with histologic findings that posed a diagnostic challenge and clinical features that were consistent with Crosti lymphoma. The patient was a 53-year-old man who consulted for a back lesion that had grown progressively over the previous 6 years. A previous biopsy performed at another center had shown an infiltrate composed of atypical lymphocytes with positivity for T-cell markers and abundant CD30<span class="elsevierStyleSup">+</span> cells. The suspected diagnosis was mycosis fungoides with CD30<span class="elsevierStyleSup">+</span> cells. No additional immunohistochemical information was available. A staging study consisting of computed tomography (CT) of the chest and abdomen and routine blood tests was normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed several tumors and plaques surrounded by erythematous macules in the lumbar region and on the left flank (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no signs of organomegaly or lymph node enlargement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A biopsy performed at our center showed a nodular lymphoid proliferation with a tendency to coalesce extending throughout the dermis and into the hypodermis, with no evidence of epidermotropism (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The lesion was composed of medium and large B cells that were positive for CD20 and CD79 and negative for CD3, CD10, CD23, and CD43; there were also, however, abundant CD3<span class="elsevierStyleSup">+</span>, CD5<span class="elsevierStyleSup">+</span>, and CD7<span class="elsevierStyleSup">+</span> T cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Immunostaining was positive for bcl-6 in the large cells and in some of the smaller cells. There was also bcl-2 positivity, but this was difficult to interpret due to the presence of large number of T cells. The cells were negative for CD30, contrasting with the results from the previous biopsy. Approximately 15% of the cells were positive for Ki67. Immunogenotyping revealed clonal rearrangement of immunoglobulin heavy locus (<span class="elsevierStyleItalic">IHG</span>) genes and a lack of T-cell receptor gene (<span class="elsevierStyleItalic">TCR</span>) rearrangement.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the basis of these findings, we ordered a staging study consisting of general blood tests (including analysis of lactic acid dehydrogenase and β-2 microglobulin levels), a chest and abdomen CT scan, and a bone marrow biopsy. The results were all normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main entity considered in the differential diagnosis was marginal zone B-cell lymphoma which, unlike cutaneous FCL, tends to be bcl-6-negative. We also considered diffuse large B-cell lymphoma, leg-type, but this is characterized by a diffuse monomorphous infiltrate with large numbers of large bcl-2<span class="elsevierStyleSup">+</span> and MUM-1<span class="elsevierStyleSup">+</span> cells. Because of the large number of T cells observed, we also initially considered mycosis fungoides and pseudolymphoma, but ruled these out on the basis of the clinical presentation, the type of infiltrate, the presence of <span class="elsevierStyleItalic">IGH</span> clonal rearrangement, and the lack of <span class="elsevierStyleItalic">TCR</span> clonal rearrangement<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (although it should be noted that <span class="elsevierStyleItalic">TCR</span> clonal rearrangement is not always detected in early mycosis fungoides<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">On correlating clinical and pathologic findings, Crosti lymphoma was considered the most likely diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This classic variant of cutaneous FCL is characterized by a B-cell infiltrate with follicle center cells and a variable number of centroblasts that may be accompanied by abundant reactive T cells.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Pan B-cell markers and germinal center markers tend to be positive, but the latter may be negative in FCL with a diffuse growth pattern.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Unlike in follicular lymphoma of nodal origin, cells in Crosti lymphoma are normally not immunoreactive for bcl-2.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> Up to 15% of primary cutaneous FCLs, however, express bcl-6 (as was the case with our patient), and this aids diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Following the recommendations of the European Organisation for Research and Treatment of Cancer,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> we initiated treatment with local radiation therapy. This led to resolution of the lesions and there were no signs of recurrence after 8 months of follow-up.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have described a case diagnosed as Crosti lymphoma, which is a classic variant of primary cutaneous FCL generally characterized by a diffuse growth pattern and abundant immunoreactive T cells, although diagnosis can be complicated by an absence of germinal center markers.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> In our patient, the main confounding factor was the large T-cell population as this made it difficult to interpret immunohistochemical results and observe tumor cells. The diagnosis was established following a correlation of clinical and pathologic findings.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Morell L, Bassas-Vila J, Mate JL, Bielsa I. Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica. Actas D Dermosifiliogr.2012;103:746-748.</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" => 897 "Ancho" => 951 "Tamanyo" => 162067 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Several tumors and plaques surrounded by erythematous macules in the lumbar region and on the left flank.</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" => 1286 "Ancho" => 951 "Tamanyo" => 589442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The biopsy revealed a lymphoid proliferation with a nodular pattern extending throughout the dermis and into the hyperdermis, with no evidence of epidermotropism.</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" => 1190 "Ancho" => 1579 "Tamanyo" => 523173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed almost equal numbers of B and T cells; the T cells were predominantly CD4<span class="elsevierStyleSup">+</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous lymphomas: from morphology to chip technology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 16 | 28 |
| 2024 Octubre | 81 | 46 | 127 |
| 2024 Septiembre | 87 | 31 | 118 |
| 2024 Agosto | 126 | 87 | 213 |
| 2024 Julio | 85 | 54 | 139 |
| 2024 Junio | 99 | 60 | 159 |
| 2024 Mayo | 87 | 59 | 146 |
| 2024 Abril | 86 | 35 | 121 |
| 2024 Marzo | 89 | 34 | 123 |
| 2024 Febrero | 61 | 35 | 96 |
| 2024 Enero | 59 | 39 | 98 |
| 2023 Diciembre | 72 | 15 | 87 |
| 2023 Noviembre | 80 | 32 | 112 |
| 2023 Octubre | 79 | 23 | 102 |
| 2023 Septiembre | 76 | 21 | 97 |
| 2023 Agosto | 59 | 20 | 79 |
| 2023 Julio | 61 | 39 | 100 |
| 2023 Junio | 63 | 22 | 85 |
| 2023 Mayo | 73 | 20 | 93 |
| 2023 Abril | 58 | 21 | 79 |
| 2023 Marzo | 59 | 24 | 83 |
| 2023 Febrero | 68 | 23 | 91 |
| 2023 Enero | 61 | 51 | 112 |
| 2022 Diciembre | 57 | 40 | 97 |
| 2022 Noviembre | 31 | 30 | 61 |
| 2022 Octubre | 41 | 26 | 67 |
| 2022 Septiembre | 47 | 25 | 72 |
| 2022 Agosto | 22 | 38 | 60 |
| 2022 Julio | 31 | 25 | 56 |
| 2022 Junio | 41 | 27 | 68 |
| 2022 Mayo | 49 | 40 | 89 |
| 2022 Abril | 61 | 34 | 95 |
| 2022 Marzo | 43 | 42 | 85 |
| 2022 Febrero | 51 | 25 | 76 |
| 2022 Enero | 75 | 42 | 117 |
| 2021 Diciembre | 43 | 33 | 76 |
| 2021 Noviembre | 54 | 53 | 107 |
| 2021 Octubre | 61 | 44 | 105 |
| 2021 Septiembre | 62 | 46 | 108 |
| 2021 Agosto | 47 | 28 | 75 |
| 2021 Julio | 77 | 40 | 117 |
| 2021 Junio | 29 | 36 | 65 |
| 2021 Mayo | 43 | 35 | 78 |
| 2021 Abril | 87 | 69 | 156 |
| 2021 Marzo | 62 | 36 | 98 |
| 2021 Febrero | 68 | 20 | 88 |
| 2021 Enero | 35 | 22 | 57 |
| 2020 Diciembre | 33 | 16 | 49 |
| 2020 Noviembre | 20 | 24 | 44 |
| 2020 Octubre | 30 | 14 | 44 |
| 2020 Septiembre | 43 | 17 | 60 |
| 2020 Agosto | 17 | 16 | 33 |
| 2020 Julio | 30 | 12 | 42 |
| 2020 Junio | 53 | 24 | 77 |
| 2020 Mayo | 30 | 18 | 48 |
| 2020 Abril | 37 | 21 | 58 |
| 2020 Marzo | 44 | 20 | 64 |
| 2020 Febrero | 6 | 10 | 16 |
| 2020 Enero | 4 | 14 | 18 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 4 | 7 | 11 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 13 | 17 |
| 2019 Junio | 3 | 15 | 18 |
| 2019 Mayo | 4 | 26 | 30 |
| 2019 Abril | 2 | 14 | 16 |
| 2019 Marzo | 0 | 12 | 12 |
| 2019 Febrero | 2 | 3 | 5 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 51 | 1 | 52 |
| 2018 Enero | 59 | 6 | 65 |
| 2017 Diciembre | 67 | 8 | 75 |
| 2017 Noviembre | 39 | 3 | 42 |
| 2017 Octubre | 36 | 4 | 40 |
| 2017 Septiembre | 37 | 5 | 42 |
| 2017 Agosto | 56 | 8 | 64 |
| 2017 Julio | 43 | 4 | 47 |
| 2017 Junio | 63 | 8 | 71 |
| 2017 Mayo | 61 | 5 | 66 |
| 2017 Abril | 62 | 8 | 70 |
| 2017 Marzo | 33 | 9 | 42 |
| 2017 Febrero | 30 | 6 | 36 |
| 2017 Enero | 18 | 11 | 29 |
| 2016 Diciembre | 37 | 10 | 47 |
| 2016 Noviembre | 46 | 4 | 50 |
| 2016 Octubre | 58 | 8 | 66 |
| 2016 Septiembre | 45 | 11 | 56 |
| 2016 Agosto | 40 | 8 | 48 |
| 2016 Julio | 26 | 12 | 38 |
| 2016 Junio | 9 | 16 | 25 |
| 2016 Mayo | 6 | 19 | 25 |
| 2016 Abril | 3 | 1 | 4 |
| 2016 Marzo | 7 | 0 | 7 |
| 2016 Febrero | 8 | 3 | 11 |
| 2016 Enero | 8 | 2 | 10 |
| 2015 Diciembre | 7 | 2 | 9 |
| 2015 Noviembre | 25 | 4 | 29 |
| 2015 Octubre | 20 | 7 | 27 |
| 2015 Septiembre | 13 | 5 | 18 |
| 2015 Agosto | 8 | 6 | 14 |
| 2015 Julio | 45 | 9 | 54 |
| 2015 Junio | 40 | 5 | 45 |
| 2015 Mayo | 56 | 7 | 63 |
| 2015 Abril | 59 | 9 | 68 |
| 2015 Marzo | 57 | 7 | 64 |
| 2015 Febrero | 51 | 6 | 57 |
| 2015 Enero | 47 | 15 | 62 |
| 2014 Diciembre | 54 | 8 | 62 |
| 2014 Noviembre | 45 | 10 | 55 |
| 2014 Octubre | 57 | 14 | 71 |
| 2014 Septiembre | 20 | 2 | 22 |
| 2014 Agosto | 28 | 2 | 30 |
| 2014 Julio | 23 | 2 | 25 |
| 2014 Junio | 29 | 2 | 31 |
| 2014 Mayo | 42 | 3 | 45 |
| 2014 Abril | 45 | 3 | 48 |
| 2014 Marzo | 45 | 10 | 55 |
| 2014 Febrero | 33 | 8 | 41 |
| 2014 Enero | 28 | 5 | 33 |
| 2013 Diciembre | 38 | 7 | 45 |
| 2013 Noviembre | 23 | 6 | 29 |
| 2013 Octubre | 20 | 5 | 25 |
| 2013 Septiembre | 23 | 4 | 27 |
| 2013 Agosto | 29 | 11 | 40 |
| 2013 Julio | 12 | 19 | 31 |
| 2013 Junio | 12 | 17 | 29 |
| 2013 Mayo | 12 | 10 | 22 |
| 2013 Abril | 16 | 10 | 26 |
| 2013 Marzo | 19 | 5 | 24 |
| 2013 Febrero | 39 | 7 | 46 |
| 2013 Enero | 29 | 4 | 33 |
| 2012 Diciembre | 24 | 6 | 30 |
| 2012 Noviembre | 1 | 1 | 2 |
| 2012 Octubre | 2 | 4 | 6 |
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