eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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5/2020
vol. 37
 
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Letter to the Editor

Clinical manifestations of diffuse large B‑cell lymphoma in the skin and subcutaneous tissue a case series study

Katarzyna Dulik
1
,
Grażyna Kamińska-Winciorek
1
,
Ryszard Swoboda
1
,
Anna Kwiatkowska-Pamula
1
,
Sebastian Giebel
1

1.
Department of Bone Marrow Transplantation and Oncohematology, Maria Sk³odowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice Branch, Gliwice, Poland
Adv Dermatol Allergol 2020; XXXVII (5): 812-816
Online publish date: 2020/11/07
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Diffuse large Bcell lymphoma (DLBCL) is the most common subgroup of nonHodgkin lymphoma, accounting for 30% to 40% of cases [1]. The most common symptom is lymphadenopathy (about 70%) or involvement of other organs (30%), including the gastrointestinal tract, skin and soft tissue, urogenital system, bones, respiratory system, thyroid, salivary gland, and breast. The presence of extranodal lesions is associated with a worse prognosis [2].
The paper presents 4 patients diagnosed with DLBCL with secondary involvement of the skin and subcutaneous tissue, treated at the Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology in 2017. In all cases the diagnosis was made on the basis of histopathologic examination with immunophenotyping of tumour sections from the internal organs, skin and subcutaneous tissue, and lymph nodes, affected by the disease process. Case 1: A 68yearold female patient with follicular lymphoma (FL) G2 diagnosed in April 2014 on the basis of histopathological examination of abdominal tumour located between the intestinal loops and the rectus abdominis muscle. Because of two disease relapses, the patient was treated with chemotherapy and radiotherapy, each time with a complete remission assessed by computed tomography. In March 2017, extensive oedema involving the skin and subcutaneous tissue appeared in the upper half of the right thigh, also affecting the right inguinal region. Despite the use of bendamustine monotherapy, there was rapid progression of isolated infiltrative lesions in the skin and subcutaneous tissue, initially located in the right thigh (Figure 1 A), with subsequent hard infiltration on erythematous background, and numerous blisters with formation of ulcerations covered with bloody crusts (Figures 1 B, C), which was confirmed by computed tomography. The fifth line of treatment was administered according to the RDHAP regimen (rituximab, cisplatin, cytarabine arabinoside, dexamethasone). Histopathological examination with immunophenotyping of cutaneous and subcutaneous tissue revealed transformation of FL to DLBCL, with BCL2/cMyc expression, corresponding to doubleexpressor lymphoma. The therapy used in this patient (four RDHAP cycles) resulted in a significant reduction of tumour mass in the right thigh, with complete resolution of skin lesions (Figure 1 D). Unfortunately, during the preparation for bone marrow autotransplantation, there was a...


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