Skin lesions as the first manifestation of follicular lymphoma

Introduction:
Follicular lymphoma is the second most common type of lymphoma, originating from B cells. It presents with long-term asymptomatic lymphadenopathy and involvement of other organs is rare.

Case report:
A 92-year-old woman reported to the Department of Dermatology with skin lesions persisting for 6 months. She had previously been treated for erysipelas and “a tumour of unknown origin”. A biopsy had been taken in the past, but the microscopic image was non-specific. The patient was thus treated with antibiotics, without further diagnostics. At the department, numerous firm pink-red nodules on the right lower leg were observed. Another biopsy was taken – the microscopic image and immunohistochemical profile were consistent with secondary skin involvement by follicular lymphoma. The patient was referred to the Lymphatic Tumour Centre, but refused further treatment and soon died.

Conclusions:
Secondary skin involvement by follicular lymphoma is very rare and diagnosis may be delayed. If the histopathological result does not match the clinical picture of the skin lesions, a repeat biopsy is indicated.