Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature

Abstract

Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400 cGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500 cGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12 months of radiotherapy, being free from local recurrence and systemic spread of the disease.

Primary Cutaneous Follicle Center Lymphoma of the Eyelid: A Case Report and Review of the Literature in Light of Recent Changes to the WHO Classification of Lymphoid Neoplasms

“…Typically, most lesions show a nodular (in follicular growth pattern) to diffuse infiltrate that involves the entire dermis and can extend into the subcutaneous adipose tissue but spares the epidermis [2, 8]. A follicular pattern is more often observed in scalp lesions than in lesions of the trunk [2, 14].…”

“…The cells involved include centrocytes, centroblasts, reactive T cells, and large neoplastic B cells. Large, multi-lobulated centrocytes are particularly characteristic of PCFCL [2, 8]. As lesions progress, the neoplastic B cells increase in number and size, while the proportion of reactive T cells decreases, and recognizable follicular structures disappear [2].…”

“…Classically, PCFCL presents as single or multiple erythematous plaques or nodules grouped at a single site on the head, neck, trunk, and much less commonly on the lower extremities [2, 8]. The lesions are typically non-ulcerated.…”

“…The histopathology of PCFCL varies depending on the size, duration, and clinical stage of the lesion [8]. Typically, most lesions show a nodular (in follicular growth pattern) to diffuse infiltrate that involves the entire dermis and can extend into the subcutaneous adipose tissue but spares the epidermis [2, 8].…”

“…In addition to biopsy, initial workup should include complete physical examination, laboratory testing, chest X-ray, computed tomography of the chest, abdomen and pelvis, and a bone marrow biopsy. Laboratory testing should include complete blood count, urinalysis, liver function tests, lactate dehydrongenase, C-reactive protein, protein electrophoresis, immunoglobulins, and serologic testing for hepatitis, Borrelia burgdorferi , and HIV [8]. A lesion can only truly be defined as PCFCL when skin disease is present alone for at least 6 months after complete staging [6].…”