Linfoma cutâneo primário de grandes células B de apresentação atípica: relato de caso

Abstract

Primary cutaneous lymphomas are defined as lymphocytic neoplasias that present themselves clinically in the skin without extracutaneous disease at diagnosis and up to 6 months after it. The authors report the case of an elderly male patient, with a three-month-history of papules in the axilla which evolved into painful ulceration. Examination found deep ulcer with irregular borders ,infiltrates, in the right axilla. Physical and additional examinations did not evidence disease at distance. Histopathology revealed dense and diffuse dermic sample infiltrate of atypical lymphocytes. Imunohistochemistry shows expression of CD20 and bcl-2 antigens , with negative CD10, configuring diagnosis of cutaneous large B-cell lymphoma. In this type of cutaneous lymphoma, primary cutaneous manifestation is rare ,the incidence in men is lower and it is most commonly located in the lower limbs. Keywords: Immunohistochemistry; Lymphoma, Large B-Cell, Diffuse; Skin ulcer Resumo: Linfomas cutâneos primários são definidos como neoplasias linfocíticas que se apresentam clinicamente na pele sem doença extracutânea no momento do diagnóstico e até por 6 meses após. Os autores relatam o caso de um paciente masculino, idoso, com história de pápulas em axila, há 3 meses, que evoluí-ram para ulceração. Ao exame, úlcera profunda de bordos irregulares, infiltrados, em axila direita. Exames físico e complementares não evidenciaram doença à distância. O histopatológico mostra infiltrado dérmico denso e difuso de linfócitos atípicos. A imuno-histoquímica evidencia expressão de antígenos CD20 e bcl-2, com CD10 negativo, configurando diagnóstico de linfoma cutâneo difuso de grandes células B. Neste tipo de linfoma, é rara a manifestação cutânea primária, assim como a incidência é menor em homens e a localização, mais comum em membros inferiores.

Primary cutaneous follicle center lymphoma

“…Primary cutaneous lymphoma features a more indolent natural history than the secondary form of the disease, with good prognosis. 3 It manifests itself at an average age of 58 years, consistent with our patient's age, with a 5-year survival rate of 95%. Cutaneous manifestations can be papules or nodules and their most frequent location are the head, scalp, and trunk.…”

Primary cutaneous follicle center lymphoma

“…Although the two variants are identical in morphological appearance, they have different clinical behaviors. Primary cutaneous lymphoma features a more indolent natural history than the secondary form of the disease, with good prognosis 3. It manifests itself at an average age of 58 years, consistent with our patient's age, with a 5-year survival rate of 95%.…”

Primary cutaneous non-Hodgkin's lymphoma, clinically mimicking a soft tissue sarcoma

“…[ 2 ] Primary CBCLs are less frequent and comprise only 20%–25% of all PCLs. [ 3 ] Primary cutaneous B-cell lymphomas are a heterogeneous group of lymphomas with distinct biology and clinical course when compared to their nodal counterparts. We discuss a case of an aggressive CBCL that clinically and radiologically mimicked soft tissue sarcoma.…”