Isolated skeletal muscle recurrence of an originally nodal diffuse large B cell lymphoma

Abstract

Rationale:Diffuse large B cell lymphoma (DLBCL) is a malignancy of the B cells with extranodal primary involvement being estimated at 30% to 40% of cases. Primary skeletal muscle presentation of DLBCL is extremely rare, with an estimated incidence of about 0.5% of extranodal lymphomas, presenting mostly in the lower extremities. The possible mechanisms of muscle involvement of DLBCL include primary extranodal disease, extension from adjacent organs (such as lymph nodes) or disseminated disease.Patient concerns:We report a case of a 70-year-old woman with an advanced initially nodal DLBCL, treated with R-CHOP, that presented with an enlargement of her left thigh and restricted mobility 3 months after completion of chemotherapy. Imaging studies were performed, which showed possible infiltration of the muscles of the left thigh, without any nodal disease present.Diagnoses:Muscle biopsy documented the recurrence of the lymphoma at the left thigh.Interventions:The patient started second-line treatment with gemcitabine and vinorelbine.Outcomes:A partial response was achieved after the first cycle.Lessons:The remarkable element lies in the reappearance of the lymphoma at the left thigh muscles, with no radiographic or clinical evidence of involvement of lymph nodes, despite the extensive lymph node disease at initial presentation. The further management of such recurrences remains to be clarified, as the odd biological behavior of the malignant cells dictates a special handling of the disease.

Primary multifocal muscular T‐cell lymphoma with cutaneous involvement in a dog: A case report and review of the literature

“…3,4 The most commonly affected muscles are the muscles of the extremities, [14][15][16] which has also been noted in the canine cases. Recurrence of multicentric nodal lymphoma within the muscle has also been reported in people, 17,18 as has been muscular and cutaneous lymphoma as a part of disseminated disease. 19 A case of primary skeletal muscle non-Hodgkin's B-cell lymphoma with cutaneous involvement and without evidence of other systemic dissemination has been reported in a male patient, although no immunophenotyping of the cutaneous lesions was undertaken.…”

Imaging features of skeletal muscle lymphoma: a case report and literature review

“…This feature may reflect the degree of muscle involvement [ 11 , 27 ] and correlate with histological findings that show neoplastic lymphocytes surrounding and invading myofibrils [ 27 , 28 ]. Color and power Doppler US may show hypervascularity [ 25 , 29 ]. Real-time US-guided core needle biopsy is often used for diagnosis of skeletal muscle lymphoma, and was applied in the present case.…”

“…The combination of chemotherapy and immunotherapy (R-CHOP) with or without radiation therapy is considered standard therapy for DLBCL [ 32 ]. This approach achieves a good response in patients with skeletal muscle lymphoma [ 29 , 32 , 33 ]. However, a meta analysis [ 24 ] revealed that DLBCL of the soft tissue is aggressive and associated with poor prognosis, requiring further studies to better characterize this peculiar entity.…”

Isolated Solitary Asymptomatic Skeletal Muscle Relapse of High-Grade Lymphoma Detected on Surveillance 18F- Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography

“…[ 2 ] In most cases, skeletal muscle involvement is associated with other sites of involvement as well. [ 3 ] While 30%–40% of patients with DLBCL will relapse, isolated skeletal muscle relapse is extremely rare,[ 4 ] as was seen in the present case. 18 F-FDG PET-CT is now an integral part of the management of patients with lymphoma, especially DLBCL.…”