Spontaneous Regression Of Primary Cutaneous Diffuse Large B-cell Lymphoma, Leg Type With Significant T-cell Immune Response
Graham, P. M., Richardson, A. S., Schapiro, B. L., Saunders, M. D., & StewART, D. M. (2018). spontaneous regression of primary cutaneous diffuse large B-cell lymphoma, leg type with significant T-cell immune response. JAAD case reports, 4(4), 305–309. https://doi.org/10.1016/j.jdcr.2017.10.012
View Original Source →Abstract
We report a case of histologically confirmed primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) that subsequently underwent spontaneous regression in the absence of systemic treatment. The case showed an atypical lymphoid infiltrate that was CD20+ and MUM-1+ and CD10–. A subsequent biopsy of the spontaneously regressed lesion showed fibrosis associated with a lymphocytic infiltrate comprising reactive T cells. PCDLBCL-LT is a cutaneous B-cell lymphoma with a poor prognosis, which is usually treated with chemotherapy. We describe a case of clinical and histologic spontaneous regression in a patient with PCDLBCL-LT who had a negative systemic workup but a recurrence over a year after his initial presentation.
Case Details
Disease Location
Left leg (left anterior shin)
Personal Characteristics
79 -year-old male caucasian
Clinical Characteristics
Primary cutaneous large b-cell lymphoma, leg type presented with plaque on his left leg that was present for 1 week physical exam found a 20x12cm irregular, rectangular-shaped, erythematous, reticulated plaque on his left anterior shin with prominent follicular accentuation biopsy found an atypical lymphoid infiltrate in the upper dermis composed of cells with scant cytoplasm and large round-to-oval nuclei with prominent nucleoli, numerous mitotic figures, and apoptotic bodies the atypical cells were positive with CD20, mum-1, bcl-2 and bcl-6 stains. A CD3 stain showed a minor component of small, round lymphocytes findings were compatible with pcdlbcl-lt 4 cycles of r-chop followed by local radiation was recommended but declined by the patient patient remained disease-free for more than a year but then presented more than a year later with new plaque confirmed as recurrence of pcdlbcl-lt
Remission Characteristics
A months later after clinical findings, significant improvement of the lesion was seen in the absence of any systemic treatment the plaque spontaneously resolved, and a punch biopsy of the area found a superficial and deep perivascular inflammatory infiltrate comprised of mature lymphocytes. The atypical, pleomorphic lymphoid infiltrate seen in the previous viopsy was no identified. Ihc showed significant CD3+ t cells with a minority of CD20+ b cells these histologic findings ere consistent with sr of the pcdlbcl-lt head, chest, abdomen and pelvis CT were all negative for lymphoma and lymphadenopathy bone marrow aspirate and biopsy of the right iliac bone was negative for malignancy the patient remained disease free for more than a year
Treatment & Mechanisms
Proposed Remission Mechanisms
Presence of t-cell infiltration may have an imporightant role in sr
Non-Clinical Treatment
None reported