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| IMAGE IN HEMATOLOGY |
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| Year : 2021 | Volume
: 12
| Issue : 4 | Page : 236-237 |
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Primary cutaneous diffuse large B-cell lymphoma, leg type
Keechilat Pavithran1, Indu R Nair2
1 Department of Medical Oncology, Amrita Institute of Medical Science and Research Center, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
2 Department of Pathology, Amrita Institute of Medical Science and Research Center, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| Date of Submission | 07-Feb-2021 |
| Date of Decision | 30-Mar-2021 |
| Date of Acceptance | 10-Apr-2021 |
| Date of Web Publication | 18-Jan-2022 |
Correspondence Address:
Dr. Keechilat Pavithran
Department of Medical Oncology, Amrita Institute of Medical Science and Research Center, Amrita Vishwa Vidyapeetham, Kochi, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/joah.joah_11_21
How to cite this article:
Pavithran K, Nair IR. Primary cutaneous diffuse large B-cell lymphoma, leg type. J Appl Hematol 2021;12:236-7 |
A 56-year-old male presented with multiple swellings of varying size over the right leg with edema [Figure 1]. There was no lymphadenopathy. He had treatment with topical steroids, but the lesion progressed, so he underwent a skin biopsy. It showed an atypical mononuclear infiltrate. On immunohistochemistry, the cells were positive for CD20, B-cell lymphoma 2 (BCL-2), focally for MUM-1 and negative for CD10 and BCL-6. CD23 does not show any follicular dendritic cell (FDC) meshwork. Ki-67 index was 50%. These findings were consistent with primary cutaneous diffuse large BCL, leg type (PCDLBCL-LT). A whole-body 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) showed abnormal increased FDG uptake in multiple subcentimetric soft-tissue density seen surrounding the lower half of the right leg (SUV Max 10.5) [Figure 2]a. Follow-up evaluation by 18F-FDG PET/CT showed complete response after 4 cycles of combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) [Figure 2]b. Posttreatment (6 cycles of R-CHOP), he is on regular follow-up and is doing well for the past 6 years. PCDLBCL-LT is very rare accounting for <5% of all cutaneous lymphomas. PCDLBCL-LT usually affects elderly females (mean age: 70 years). They present with red to bluish nodules or tumors with or without ulceration on one or both lower legs. Only about 10%–15% of patients have lesions outside the lower extremities. They are more aggressive with worse outcomes. The prognosis of PCDLBCL-LT is poor, with a 5-year survival rate of 41%–58%. This case is unusual being a young male and with long-term survival. | Figure 1: Multiple cutaneous swellings of varying size over the right leg
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 | Figure 2: (a) F-Fluorodeoxyglucose positron emission computed tomography showing abnormal increased fluorodeoxyglucose uptake in multiple subcentimetric soft-tissue density seen surrounding the lower part of the right leg. (b) Shows complete disappearance of fluorodeoxyglucose activity after 4 cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2]
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