Cutaneous B‐cell Lymphoma Consisting of Large Cleaved Cells With Multilobated Nuclei

Abstract

A 65‐year‐old man was seen at the Ushioda Hospital in Au‐gust 1989, because of a 1‐month history of a tumor on the scalp. The tumor was excised and the diagnosis was malig‐nant lymphoma. The patient was then referred to our de‐partment in September 1989. Several nut‐sized lymph nodes wvepa‐b and m‐fepa for 2 months. Since then, the patient has been free of disease up to the time of writing, July 1992, a period of 2.5 years. Biopsy samples taken from the tumor on the scalp showed a monomorphous infiltrate of large lymphoid cells throughout the entire dermis and subcutis, with a definite clear zone (Fig.1). A high‐power view showed diffuse large lymphoid cell infiltration. Numerous mitotic figures were also seen. The lymphoid cells had multilobated nuclei and distinct nucleoli (Fig. 2). Monoclonal antibodies such as Leui (CD5), Leu2a (CD8), Leu3a (CD4), Leu4 (CD3), MT‐1 (CD43), Leu14 (CD22), LN1 (CDw75), and Leu26 (CD20), and polyclonal antibodies such as anti‐kappa, anti‐lambda, anti‐IgG, anti‐lgA, anti‐IgM, and anti‐lgD were purchased from commercial sources. Optimal dilutions of the monoclonal antibodies and heteroantisera were assessed beforehand by titration on suitable tissue samples. The antigens recognized by the monoclonal anti‐bodies and heteroantisera were investigated by either the avidin‐biotin peroxidase complex (ABC) method on cryostat sections or the peroxidase‐antiperoxidase complex (PAP) method on paraffin sections, as described elsewhere.1 The immunologic properties of the infiltrating cells were determined using skin biopsied in August 1989, and October 1989. Large lymphoid cells, which formed the major popu‐lation of infiltrating cells, were positive for CD20, CD22, and HLA‐DR and negative for CD3, CD4, CD43, and CD45RO. From these findings the patient was diagnosed as hav‐ing primary cutaneous B‐cell lymphoma, diffuse large non‐cleaved cell type, as classified by the Working Formulation.2

The multilobated morphology is still a better prognosis factor of diffuse large B‐cell lymphoma in the R‐CHOP era

“…During the dramatic advances in histology in the area of lymphoma from 1970 to 1990, many concerns about multilobated B-cell lymphoma were declared although most of the clinicopathological studies of multilobated B-cell lymphoma described a relatively good prognosis in the CHOP era. [12][13][14][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Few additional reports about ml-DLBCL have appeared afterward. Exceptionally, Shimano et al 39 reported a poor prognosis group of DLBCL with a polyploid chromosomal abnormality that showed histological findings of Hodgkin's-like giant and multilobated cells.…”

“…During the dramatic advances in histology in the area of lymphoma from 1970 to 1990, many concerns about multilobated B‐cell lymphoma were declared although most of the clinicopathological studies of multilobated B‐cell lymphoma described a relatively good prognosis in the CHOP era 12–14,16–29 . Few additional reports about ml‐DLBCL have appeared afterward.…”

“…Common histological variants of DLBCL are of centroblastic, immunoblastic, and anaplastic types, and multilobated DLBCL (ml‐DLBCL) is found in rare instances 1 . Although the multilobated morphology was first reported as a morphologic variant of T‐cell lymphoma, it was also found in B‐cell lymphoma and was reported to relate to better prognosis 11–34 . In the updated Kiel classification, the multilobated subtype of B‐cell lymphoma were defined in detail: (i) more than 10%–20% of tumor cells showed lobated nuclei, (ii) some nuclei having three or four lobations, (iii) fine chromatin, and (iv) unrecognized nucleoli 35 .…”

“…A revised European–American classification of lymphoid neoplasms (REAL classification) and recent WHO classifications were also inevitable to discuss ml‐DLBCL 1,2 . However, this morphology has been relatively forgotten and described only as a rare instance, with a relationship to bone and other extranodal sites 11–34 …”