Solitary plaque on the scalp as a primary manifestation of Hodgkin lymphoma: a case report and review of the literature

Abstract

Cutaneous Hodgkin lymphoma is infrequent and typically occurs after extensive involvement of the lymph nodes. The condition decreased significantly in incidence in the past two decades, likely owing to the new treatment protocols composed of chemotherapy, radiotherapy and stem cell transplantation. Nevertheless, recognition of this uncommon but significant disease manifestation is important from a prognostic and therapeutic perspective. We are sharing a recent case of Hodgkin lymphoma where the primary presentation appeared as a solitary plaque on the left side of the occipital scalp, clinically suspected to represent a ruptured follicular cyst. The patient underwent excisional biopsy. Histological assessment revealed Hodgkin lymphoma affecting the skin. Radiological studies showed no regional lymphadenopathy. However, two enlarged lymph nodes were identified in the mediastinum and were positron emission tomography avid. The patient underwent systemic treatment without further histopathological examination of these two lymph nodes. Not being clear if these enlarged two lymph nodes were related to his cutaneous disease or not, we cannot be sure if the patient was afflicted either by primary cutaneous Hodgkin lymphoma or by secondary cutaneous involvement because of hematogenous spread. In either case, primary or secondary cutaneous Hodgkin disease is an extreme rarity. The literature is critically reviewed.

Concurrent malignant melanoma and cutaneous involvement by classical hodgkin lymphoma (CHL) in a 63 year-old man

“…The B-cell nature of Reed-Sternberg cells is shown by the B-cell specific activator protein (BSAP), product of the PAX-5 gene in approximately 90% of cases. Additionally the tumor cells can be positive for EBER, by in-situ hybridization [1,5,6]. Other immunohistochemical markers that have some utility are OCT-2 and BOB-1, which are positive (not both) in up to 90% of cases [1].…”

“…Other immunohistochemical markers that have some utility are OCT-2 and BOB-1, which are positive (not both) in up to 90% of cases [1]. In contrast, LyP, c-ALCL, or transformed MF show invariable negative expression of CD15 or Pax-5 [4,6]. A systemic B-cell lymphoma that can sometimes enter in the differential diagnosis is T-cell histiocyte-rich large B-cell lymphoma (THRLBCL).…”

Specific Skin Infiltration as First Sign of Localized Stage Hodgkin's Lymphoma Involving an Epitrochlear Node

“…Both direct extension from an underlying affected node and hematogenous dissemination have been also described. 12 Epitrochlear involvement in HL, like in our case, is a rare event (,1%), although it has similar prognosis to that of other HL locations if appropriately treated. 25 Finally, in North America and western Europe, 30%-50% of HL is associated with EBV, with a rate of up to 90% in mixed cellularity subtype.…”

“…Primary cutaneous HL is exceedingly rare and only a few well-documented cases have claimed this diagnosis, 5,6,9,12,14,15 some of them with lately systemic involvement. Within these cases, three of the cases reported by Sioutos et al could be more accurately considered lymphomatoid papulosis because of their waxing and waning chronic clinical course.…”

“…25 Finally, in North America and western Europe, 30%-50% of HL is associated with EBV, with a rate of up to 90% in mixed cellularity subtype. 6 There are several cases of EBER and LMP1 positive HL 6,12 that strongly favor HL diagnosis over CD30 + lymphoproliferative disorders. 6 The lack of association with EBV in our patient is an infrequent feature of HL, 6 and is particularly diagnostically challenging in separating HL from cutaneous CD30 + lymphoproliferative disorders.…”