Follicular Lymphoma of the Skin | Spontaneous Remission Database

Case Details

Disease Location

Scalp

Personal Characteristics

83 -year-old female puertorican developed congestive heart failure secondary to hypertension and arteriosclerotic heart disease in about 1960. Chest x-rays at that time revealed slight left ventricular enlargement and mild basilar pulmonary fibrosis her condition was well controlled with digitalis, oral diuretic, and antihypertensive medication in 1962, she had slightly elevated hemoglobin and hematocrit values consistent with a mild secondary polycythemia pulmonary function tests demonstrated abnormalities which were compatible with congestive heart failure and pulmonary fibrosis.

Clinical Characteristics

"patient was referred to the skin clinic in september 1963 with the complaint of bumps on her head of approx. 2 weeks duration physical exam revealed multiple contiguous, smooth, firm, slightly elevated violaceous nodules measuring 5-10mm in diameter in the left frontoparietal scalp region. These formed an irregular plaque 4cm by 6cm in area. Scalp hair in this area was sparse. The skin elsewhere was dry and callosities with fissures were present on her soles biopsies of the scalp lesion were performed in september and december 1963. Biopsy revealed the skin and subcutaneous tissues, except the epidermis, to be markedly infiltrated with lymphoid cells forming discrete and confluent ""follicles"" the center of these follicles were composed almost entirely of polygonal reticulum cells. These cells had pleomorphic relatively large nuclei whose nuclear chromatin pattern was relatively fine. Varying amounts of poorly defined pale cytoplasm were present. Mitotic figures and nuclear phagocytosis were prominent features in some follicles and absent in others. The reticulum cells merged with densely packed smaller lymphoid cells at the periphery of the follicles. These latter cells were slightly larger than normal small lymphocytes. Their nuclei were hyperchromatic and the cells had small amounts of cytoplasm these cells were observed between the dermal collagen bundles, in the subcutaneous fat, and around the skin appendages these neoplastic follicles had attenuated the overlying epidermis, being separated from it by a very narrow band of collagen fibers condensation and compression of reticulum fivers at the periphery of the follicles were present while their centers contained moderate amounts of branching fivers of varying thickness the diagnosis of follicular lymphoma, reticulum-cell type was made. The patient didn't return to the clinic until august 1964 in september 1964, physical revealed a spleen palpable one finger breadth below the left costal margin, hemoglobin was 15gm/100cc; rbc 6900000/c.mm; platelets 258000/c.mm; reticulocytes 1.11%; wbc 9,950/c.mm with 66% neutrophils, 26% lymphoid cells, 6% monocytes, and 2% basophils. Most of the peripheral lymphoid cells were abnormal and of a type seen in patients with lymphosarcoma, these cells were larger than normal and had higher nuclear:cytoplasmic ratios than normal their nuclei contained increased chromatin consisting for irregularly shaped chromo-centers with chromatin bands of variable length and thickness. Their cytoplasm was light blue with lighter colored ""vacuoles"", minute cytoplasmic pseudopods and increased numbers of granules were frequently present, particularly in the larger lymphoid cells. The rbc were essentially normocytic and slightly hypochromic. Slight rouleaux formation was present sternal marrow aspiration was moderately hypercellular. Neoplastic lymphoid cells were present in patchy focal aggregations. These neoplastic lymphoid cells were mainly of the small ""mature"" type some prolymphocytes and lesser numbers of lymphoblasts were present. Transitional cells among these cell types were observed. All of the cells had very high nuclear:cytoplasmic ratios. Nuclei was generally spherical, with occasional slightly notched lobulated nuclei with irregular excrescences these lymphoid cells had increased nuclear chromatin with a disorganized pattern. This consisted of irregularly sized chromo-centers having chromatin bands of variable thickness and length prolymphocytes and lymphoblasts had a similar nuclear structure and relatively larger amounts of basophilic cytoplasm erythroid cells were normoblastic, mast cells were moderately increased in number. These cells were localized either among the lymphoid cells or in the connective tissue reticulum. Malignant associated change (mac) was present in peripheral blood and bone marrow cells most lymphoid cells were small, a lesser % of larger immature cells were seen with transitional forms between the two major cell types. The cells had the same structural characteristics as the bone marrow vdrl and serum complement fixation were both weakly reactive. Reiter protein complement fixation was 3+. Total serum protein was 7.7/100cc with albumin 3.2 and globulin 4.5gm/100cc. Serum protein electrophoresis revealed albumin 40.5%, alpha1-globulin 2.7%, alpha2 5%, beta-globulin 17.9%, lambda-globulin 33.9%. Uric acid was 6.1/100cc. Serologic tests for syphilis were positive, but were considered biologically false-positive reactions"

Remission Characteristics

During the 8 months period from clinic visits, most of the scalp lesion had spontaneously involuted only two small, contiguous, erithematous, firm nodules measuring 0.8 and 0.4cm in diameter remained in the region in october 1964, the smaller scalp nodule regressed and the larger one had softened these disappeared by december, leaving a poorly defined area of atrophic skin, 4.0x6.0cm with zones of hypopigmentation and hyperpigmentation the patient felt well

Treatment & Mechanisms

Proposed Remission Mechanisms

There may be some relationship to histologic type considered local trauma but were doubted by the authors no major mechanism proposed

Clinical Treatment

None reportedother than medication prescribed for her heart condition

Non-Clinical Treatment

None reported