Korean J Hematol.  2011 Dec;46(4):283-286. 10.5045/kjh.2011.46.4.283.

Primary cutaneous B-cell lymphoblastic lymphoma in an elderly man

• Cho SY
• Lee SS
• Back DH
• Lim KA
• Lee YR
• Kang HJ

• KMID: 2251991
• DOI: http://doi.org/10.5045/kjh.2011.46.4.283

Abstract

Precursor B-cell lymphoblastic lymphoma (B-LBL) is an uncommon high-grade neoplasm of immature B cells. It occurs predominantly in childhood with extranodal involvement such as skin and bone. Therefore, primary cutaneous involvement in elderly adults is a very rare manifestation of B-LBL. Here, we report a 78-year-old man with B-LBL presenting as a single cutaneous lesion which was immunohistochemically positive for leukocyte common antigen (LCA), CD79a, paired box 5 (PAX5), B cell lymphoma-2 (bcl-2), and terminal deoxynucleotidyl transferase (TdT) staining, but was without systemic involvement. The patient was treated using cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP), and achieved complete response (CR) at the first response assessment conducted after 3 CHOP cycles. After an additional cycle of CHOP treatment, radiotherapy was administered at a total dose of 3,600 cGy over 4 weeks. At the 21-month follow-up, he had maintained CR.

Keyword

Precursor B-cell lymphoblastic leukemia-lymphoma; Cutaneous; Adult; CHOP; Radiotherapy

MeSH Terms

Adult
Aged
Antigens, CD45
B-Lymphocytes
Cyclophosphamide
DNA Nucleotidylexotransferase
Doxorubicin
Follow-Up Studies
Humans
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Precursor Cells, B-Lymphoid
Prednisolone
Skin
Vincristine
Antigens, CD45
Cyclophosphamide
DNA Nucleotidylexotransferase
Doxorubicin
Prednisolone
Vincristine

Figure

• 

  Fig. 1 (A) At diagnosis, a 50×60 mm non-tender, non-itching, and dark red tumor with smooth surface was present on the right upper abdominal quadrant. (B) After the 3rd session of cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) chemotherapy, the tumor disappeared by gross examination. (C) 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan shows a single hypermetabolic lesion (arrow) in the abdominal wall (standardized uptake value [SUV]=12.8).

• 

  Fig. 2 (A) Microscopically, skin biopsy specimen revealed diffuse infiltration of small to intermediate lymphoid cells in the dermis and subcutaneous fat (hematoxylin & eosin [H&E], original magnification ×200). (B) High magnification shows monotonous tumor cells with slightly convoluted nuclei with fine chromatin and occasionally nucleolus and scant cytoplasm (H&E, original magnification ×1,000). (C-F) Photographs of immunohistochemical staining. Most tumor cells are positive for leukocyte common antigen (LCA) (C), CD79a (D), paired box 5 (PAX5) (E), and terminal deoxynucleotidyl transferase (TdT) (F).

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