Primary cutaneous diffuse large B-cell lymphoma, leg type and secondary cutaneous involvement by testicular B-cell lymphoma share identical clinicopathological and immunophenotypical features

doi:10.1016/j.jaad.2011.03.031

Journal of the American Academy of Dermatology

Volume 66, Issue 4, April 2012, Pages 650-654

https://doi.org/10.1016/j.jaad.2011.03.031 Get rights and content

Background

Primary cutaneous diffuse large B-cell lymphoma (PCDLBCL), leg type can eventually disseminate to extracutaneous sites including testes. In addition, patients with testicular lymphoma can develop specific skin involvement.

Objective

We sought to describe similarities between PCDLBCL, leg type and testicular B-cell lymphoma affecting the skin.

Methods

We report two cases with typical clinicopathological and immunophenotypical features of leg type lymphoma occurring simultaneously with a testicular B-cell lymphoma. We also report an additional case of PCDLBCL, leg type with secondary testicular involvement.

Results

All cases presented with typical red tumors exclusively located on the legs. Histologically, all cases showed a diffuse nonepidermotropic infiltrate composed of large blastic cells mainly centroblastic type. Phenotype showed strong positivity for Bcl-2, MUM-1, and FOXP1. Epstein-Barr virus stains and CD30 were negative in the 3 cases. In all cases the testicular infiltration showed the same pathological and phenotypical changes to those observed in the skin.

Limitations

This was a retrospective case series study.

Conclusion

Skin involvement by testicular B-cell lymphomas and PCDLBCL, leg type are indistinguishable on the basis of pathologic and immunophenotypical features, therefore specific investigation and clinic correlation are needed.

Section snippets

Case 1

A 77-year-old man was admitted to the hospital with cutaneous erythematous tumors on the left leg (Fig 1, A). No clinical or radiologic signs of extracutaneous involvement were detected at that time. Histologic examination of the skin biopsy specimen showed dense lymphocytic infiltrate of centroblasts (large cells with round or oval nuclei and several small nucleoli) and immunoblasts. An immunohistochemical analysis identified the tumor as a CD20⁺, and a combined expression of MUM-1, Bcl-2 and

Discussion

Primary testicular lymphoma is a rare neoplasm accounting for approximately 9% of testicular malignant tumors.⁷ It is usually observed in elderly patients as a unilateral painless scrotal swelling, sometimes with a significant increase in the size of one or both testes or hydrocele.⁸ Histopathologically, a diffuse large B-cell lymphoma is the most common subtype of primary testicular lymphoma, although more aggressive subtypes, such as Burkitt lymphoma, are more prevalent in cases of secondary

References (12)

N.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
(2008)
R. Willemze et al.
WHO-EORTC classification for cutaneous lymphomas
Blood
(2005)
J.F. Seymour et al.
Primary large-cell non-Hodgkin's lymphoma of the testis: a retrospective analysis of patterns of failure and prognostic factors
Clin Lymphoma
(2001)
E.S. Jaffe
The 2008 WHO classification of lymphomas: implications for clinical practice and translational research
Hematology Am Soc Hematol Educ Program
(2009)
B. Espinet et al.
FOXP1 molecular cytogenetics and protein expression analyses in primary cutaneous large B-cell lymphoma, leg-type
Histol Histopathol
(2011)
F. Grange et al.
Primary cutaneous diffuse large B-cell lymphoma, leg type: clinicopathologic features and prognostic analysis in 60 cases
Arch Dermatol
(2007)

There are more references available in the full text version of this article.

Cited by (16)

Cutaneous B-Cell Lymphoma
2019, Hematology/Oncology Clinics of North America
Citation Excerpt :
Staging includes CBC with differential, comprehensive metabolic panel, CT of the chest/abdomen/pelvis, bone marrow biopsy, PET-CT, and peripheral blood flow cytometry.38 Testicular ultrasound is recommended for male patients with new cutaneous DLBCL given secondary cutaneous testicular DLBCL demonstrates similar presentation and pathology.53 Standard treatment of pcDLBCL is based on intravenous rituximab and combination chemotherapy.
Diffuse Systemic Large B-Cell Lymphoma with Secondary Skin Involvement
2015, Actas Dermo-Sifiliograficas
Primary testicular lymphoma
2014, Blood
Citation Excerpt :
Recommended staging is the same as that for other forms of aggressive NHL (positron emission tomography-computed tomography, bone marrow biopsy) with the addition of specific CNS staging with lumbar puncture for cerebrospinal fluid analysis by cytology and flow cytometry (since there is evidence to support improved sensitivity29) and brain magnetic resonance imaging. We recommend thorough examination of the skin because cutaneous DLBCL (leg type) and testicular DLBCL have been concurrently reported,30 and the skin is a potential site of extranodal recurrence. HIV serology should be performed.
Primary testicular lymphoma (PTL) is a rare, clinically aggressive form of extranodal lymphoma. The vast majority of cases are histologically diffuse large B-cell lymphoma, but rarer subtypes are clinically important and must be recognized. In this review, we discuss the incidence, clinical presentation, and prognostic factors of PTL and present a summary of the recent advances in our understanding of its pathophysiology, which may account for the characteristic clinical features. Although outcomes for patients with PTL have historically been poor, significant gains have been made with the successive addition of radiotherapy (RT), full-course anthracycline-based chemotherapy, rituximab and central nervous system–directed prophylaxis. We describe the larger retrospective series and prospective clinical trials and critically examine the role of RT. Although rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 21 days with intrathecal methotrexate and locoregional RT is the current international standard of care, a substantial minority of patients progress, representing an unmet medical need. Finally, we discuss new treatment approaches and recent discoveries that may translate into improved outcomes for patients with PTL.
A 78-year-old man with primary cutaneous large B-cell lymphoma-leg type: a case report and literature review
2023, Iranian Journal of Dermatology
Diffuse large B-cell lymphoma of the skin and testis: A diagnostic and staging dilemma
2023, Indian Journal of Dermatology, Venereology and Leprology
A review of CD30 expression in cutaneous neoplasms
2021, Journal of Cutaneous Pathology

View all citing articles on Scopus

: Funding sources: None.

: Conflicts of interest: None declared.

View full text

DermatopathologyPrimary cutaneous diffuse large B-cell lymphoma, leg type and secondary cutaneous involvement by testicular B-cell lymphoma share identical clinicopathological and immunophenotypical features

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Case 1

Discussion

Blood

Blood

Clin Lymphoma

The 2008 WHO classification of lymphomas: implications for clinical practice and translational research

Hematology Am Soc Hematol Educ Program

FOXP1 molecular cytogenetics and protein expression analyses in primary cutaneous large B-cell lymphoma, leg-type

Histol Histopathol

Primary cutaneous diffuse large B-cell lymphoma, leg type: clinicopathologic features and prognostic analysis in 60 cases

Arch Dermatol

Dermatopathology
Primary cutaneous diffuse large B-cell lymphoma, leg type and secondary cutaneous involvement by testicular B-cell lymphoma share identical clinicopathological and immunophenotypical features