Spontaneous Regression Of Primary Diffuse Large B-cell Lymphoma, Leg Type
Alcántara-González, J., González-García, C., Fernández-Guarino, M., & Jaén-Olasolo, P. (2014). spontaneous regression of primary diffuse large B-cell lymphoma, leg type. Actas dermo-sifiliograficas, 105(1), 78–83. https://doi.org/10.1016/j.ad.2012.07.009
View Original Source →Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL LT) accounts for approximately 20% of all primary cutaneous B-cell lymphomas and tends to present as infiltrated nodules, tumors, and plaques on the legs in the elderly. Unlike other primary cutaneous large B-cell lymphomas, it has a poor prognosis and tends to require treatment with systemic chemotherapy. We present the case of an 82-year-old patient with a 1-year history of nodules and plaques on her right leg. Biopsy led to a diagnosis of PCLBCL LT and the lesions resolved without treatment within 1 month of the first visit. This is an atypical course of PCLBCL LT and we believe that it is the first such case to be reported in the literature.
Case Details
Disease Location
Skin on right leg
Personal Characteristics
82 -year-old female history of hypertension, chronic atrial fibrillation, and 2 cerebrovascular accidnets, the second of which occurred 6 years before she underwent surgery for varicose veins in both legs and placement of a prosthesis in the right hip she regularly takes omeprazole, digoxin, torsemide, and acetylsalicylic acid
Clinical Characteristics
Primary cutaneous diffuse large b-cell lymphoma, leg type presented with asymptomatic lesions on her right leg that had appeared gradualy over the previous year. There was no fever, weight loss, or any other systemic symptoms. Initial exam revealed tumor lesions on the right leg that were rubbery and measured up to 2cm in diameter. No lesions were visible elsewhere, and there were no enlarged lymph nodes histopathology of a skin biopsy specimen revealed diffuse dermal infiltrate that was separated from the epidermis by a band of normal collagen and extended into the hypodermis. The infiltrate was composed of mainly centroblast-like and immunoblast-like neoplastic cells and few smaller cells with characteristics of mature lymphocytes. Immunohistochemistry found positive CD20, cd79a, bcl-2, bcl-6 and mum-1. Ki-67 proliferation index was 90%. Small cells were positive for CD3. Testing for ebv and cytomegalovirus IGG was positive whole body CT revealed the presence of multinodular goiter and an image that was compatible with an enlarge ln or peritoneal implant in the right iliac fossa 4 weeks later... Skin lesions were almost complete gone, a second skin biopsy was conducted she remained in clinical and lab remission until she died of a third cerebrovascular accident 4 months later
Remission Characteristics
4 weeks later after first visit, the skin lesions had almost completely disappeared, with only what seemed to be a residual erythematous-brownish macules remaining the biopsy revealed a diffuse infiltrate composed of mature t cells (CD3+) with scant foci of atypical cells expressing CD20 and bcl-2 -- findings consistent with almost complete regression
Treatment & Mechanisms
Proposed Remission Mechanisms
The infiltrate could have contributed to the regression of the malignancy
Clinical Treatment
Was receiving regular treatment consisting of omeprazole, digoxin, torsemide, and acetylsalicylic acid
Non-Clinical Treatment
None reported