Malignant lymphoma of the skin in children

A unique cutaneous presentation of Burkitt lymphoma

Few reports of cutaneous Burkitt lymphoma exist in the literature. Here, the authors describe the case of a human immunodeficiency virus-positive individual with the rare diagnosis of cutaneous Burkitt lymphoma. Three weeks before the development of his cutaneous lesions, the patient experienced bilateral lower extremity paralysis, and an epidural mass was found. Bone marrow biopsy findings and serum protein electrophoresis seemed consistent with multiple myeloma. The visible appearance of the skin lesions raised concern for cutaneous involvement by myeloma; however, the skin biopsy showed morphological and immunohistochemical features of Burkitt lymphoma. In this case report, the authors discuss the histopathologic findings of the cutaneous lesions in consideration with the bone marrow biopsy findings.

Primary pediatric gastrointestinal lymphoma

Background:

Primary non-Hodgkin's lymphoma (NHL) of the gastrointestinal (GI) tract is the most common extranodal lymphoma in pediatric age group. Yet, the overall incidence is very low. The rarity of the disease as well as variable clinical presentation prevents early detection when the possibility of cure exists.

Materials and Methods:

We studied six cases of primary GI NHL in pediatric age group with reference to their clinical presentation, anatomic distribution and histopathologic characteristics.

Results:

All were males except one. Intestinal obstruction was the presenting feature in 50%. Half the cases showed ileocaecal involvement, while large bowel was involved in 16%. Histology showed four cases of diffuse large B-cell lymphoma (DLBCL), one case of Burkitt lymphoma, and one Burkitt-like lymphoma. Immunohistochemistry for Tdt, CD20, CD3, CD30, bcl2, bcl6 confirmed the morphological diagnosis.

Conclusion:

Pediatric GI lymphoma commonly involves the ileocaecal region and presents with intestinal obstruction. A higher prevalence of DLBCL is found compared to other series. A high proliferative index is useful in differentiating Burkitt-like lymphoma from DLBCL.

Primary cutaneous B-cell lymphoma in a child

Primary cutaneous B-cell lymphoma is a B-cell lymphoma of the skin with no evidence of extracutaneous involvement at the time of diagnosis. In this report, we describe an 8-year-old boy who presented with a firm, alopecic, skin-colored, smooth nodule over the right frontal scalp. Histological examination revealed a mid-to deep-dermal mononuclear lesion. Immunohistochemical staining revealed a B-cell population that was CD10(+), CD5(-), CD21(+), and bcl2(-). This pattern of reactivity is characteristic of primary cutaneous B-cell lymphoma of follicle-center subtype. To the best of our knowledge, this is the first report of this type of cutaneous lymphoma in a child.

Primary cutaneous follicular center cell lymphoma of the nose with maxillary sinus involvement in a pediatric patient

We report a primary cutaneous follicular center cell lymphoma (PCFCCL) that arose on the nose and the left naso-labial fold, spread to the left cheek, the left maxillary sinus, and the soft palate in a 16-year-old boy. Polychemotherapy was performed and the patient is disease-free after 41 months. This case is unusual because PCFCCL rarely arises on the nose, only occasionally disseminates to extracutaneous sites, and, to our knowledge, has never been described in pediatric patients.

Cutaneous lymphoblastic lymphoma in children: report of six cases with precursor B-cell lineage

Precursor B lymphoblastic lymphomas (B-LBL) are generally rare, but appear to have a higher incidence in children than in adults. In this report, we describe in detail six cases of B-LBL presenting with cutaneous lesions. Three occurred in the scalp, one in the skin of the thigh, one in the skin of the face and breast, and one in the subcutaneous tissue of the orbit. All six patients are females ranging in age at presentation from 5 to 15 years (mean = 9.6). None of the cases had bone marrow involvement, while two had bone involvement (maxilla, distal tibia, and distal humerus in one case, and distal tibia and orbital bone in another case); only one case had lymphadenopathy (retroperitoneal). Immunohistochemical staining showed positivity for CD79a and CD43 in all six cases. LCA and L26 positivity were also each seen in one case. Staining for MIC-2 (CD99) showed strong positivity in three cases. Vimentin was positive in four cases and TdT was positive in all five patients tested. Staining for keratin, UCHL-1, or CD30 was not encountered. Cases in which cell marker studies by flow cytometry were performed showed positivity for CD10, CD19 with negative CD20, pan-T-cell, and myeloid markers. The five patients who received multiagent chemotherapy are alive with follow-up intervals of 2 to 18 years. Two patients had local recurrences and were given radiation therapy (one with repeating multiagent chemotherapy). One patient (diagnosed in 1962) died of disseminated disease; she had been treated with radiation therapy and 6MP only. Cutaneous B-LBL must be included in the differential diagnosis of small blue cell tumors, especially in children. In contrast to its T-cell counterpart, B-LBL occurs more frequently in females, tends to present as skin or bone lesions, and is associated with a potential cure, even in cases that relapse.

Precursor B-cell lymphoblastic lymphoma in childhood and adolescence: clinical features, treatment, and results in trials NHL-BFM 86 and 90

BACKGROUND

Precursor B-cell lymphoblastic lymphoma (PBLL) is a rare subtype of childhood non-Hodgkin lymphoma (NHL). The purpose of our study was to investigate frequency and clinicopathological features of PBLL in children and to test prospectively the efficacy of an ALL-type therapy for treatment of these patients.

PROCEDURE

From October, 1986, to March, 1995, 1,075 patients up to 18 years of age suffering from all kinds of NHL were registered in the two consecutive multicenter studies NHL-BFM 86 and 90. Of these, 27 patients were diagnosed with PBLL. Twenty-one PBLL patients were treated according to a BFM-ALL-type protocol: an eight-drug induction over 9 weeks was followed by an 8-week consolidation including methotrexate 5 g/m(2) x4. Patients in stages I and II continued with maintenance up to a total therapy duration of 24 months, whereas patients in stages III and IV received an additional eight-drug intensification and cranial radiotherapy (12 Gy for prophylaxis) after consolidation. Six PBLL patients were treated according to the BFM-protocol for B-NHL, stratified according to stage and tumor load and consisiting of two to six 5-day courses of chemotherapy.

RESULTS

The median age of the 27 patients with PBLL (18 boys, 9 girls) was 6.2 (range 0.7-15) years. Stages (St. Jude) were: I (n = 3), II (n = 7), III (n = 9), and IV (n = 8). Twenty-one PBLL patients had nodal disease, 6 patients had subcutaneous manifestations, and 8 patients had bone marrow disease (<25% blasts). All patients achieved remission. With a median follow-up time of 4. 25 years, the estimated probability for event-free survival (pEFS) at 10 years for the total group was 0.73 (SE 0.10). Five patients (2, 1, 1, and 1 patients at stages I, II, III, and IV, respectively) relapsed: 2 of 21 patients who were treated according to the ALL strategy and 3 of 6 who were treated according to the B-NHL-protocol.

CONCLUSIONS

PBLL accounts for 2.5% of childhood NHL. An ALL-type therapy strategy appears to be superior to a short-pulse B-NHL protocol.

Primary cutaneous Ewing's sarcoma: immunophenotypic and molecular cytogenetic evaluation of five cases

Cutaneous small blue cell tumors are relatively uncommon and include primary lesions of either adnexal or neuroendocrine differentiation, as well as metastatic disease. Extraosseous Ewing's sarcoma/malignant primitive neuroectodermal tumor (MPNET) rarely may occur as a primary, superficially based neoplasm in children and young adults. We describe a series of five cases of Ewing's sarcoma/malignant primitive neuroectodermal tumor occurring as a primary cutaneous malignancy supported diagnostically both by immunohistochemical stains and fluorescence in situ hybridization (FISH). All five cases occurred as a solitary dermal nodule and were located in the lower extremities (3 cases), the axilla (1 case), and the flank (1 case). Three of the cases were clinically polypoid. Four of the five patients were female, and age at presentation ranged form 8 to 50 years of age (median, 18 years). All five tumors consisted of nodular proliferations of monomorphous, small blue cells with round, vesicular nuclei, and scant to moderate cytoplasm that were uniformly immunoreactive for the CD99 cell surface glycoprotein in a characteristic membranous pattern. Fluorescence in situ hybridization analysis of paraffin-embedded tissue revealed that three of four tumors were positive for a chromosomal translocation involving the EWS locus at 22q12, seen in more than 90% of cases of Ewing's sarcoma/malignant primitive neuroectodermal tumor. One case was not analyzable. All five patients were treated using local excision, and two patients additionally received postoperative chemotherapy and radiotherapy. Clinical follow-up is available in three cases (median duration, 33 months) and to date none has shown evidence of either local recurrence or metastasis. Because similar cases reported in the literature have likewise had favorable clinical courses after excision, primary cutaneous Ewing's sarcoma/malignant primitive neuroectodermal tumor may represent a clinically favorable subset of this otherwise highly aggressive neoplasm.

CD56/neural cell adhesion molecule expression in primary extranodal Ki-1/CD30+ lymphoma. Report of a pediatric case with simultaneous cutaneous and bone localizations

We describe the clinicopathologic features of an unusual case of CD30+/CD50+ T-cell lymphoma in a child who presented with simultaneous primary extranodal cutaneous and bone localizations. The expression of CD56 (neural cell adhesion molecule, or NCAM) is rare in non-Hodgkin's lymphomas other than in a group of haematopoietic/lymphoid neoplasms of natural killer and natural killer-like T-cells, which usually involve extranodal sites and often pursue an aggressive clinical behavior. Coexpression of CD30 and CD56 in T-cell lymphomas is exceedingly rare, and its biological significance is unknown. Our patient responded well to an intensive chemotherapy regimen, and she is now in complete remission 4 years after discontinuation of chemotherapy. Expression of NCAM could be regarded as responsible, in part, for the extranodal localization of lymphoma cells; expression of CD56 also might contribute to the definition of a subset of CD30+ lymphomas with distinctive clinicopathologic features.

Characterization of a CD34+ cell line established from a child with large cell cutaneous lymphoma

BACKGROUND

Lymphoma presenting with skin involvement has heterogeneous morphology and rarely is seen in children. To study the pathogenesis of this disease, lymphoma cells from a child with B-cell large cell lymphoma of the skin were cultured in vitro.

METHODS

Lymphoma cells cultured on a feeder layer under hypoxic conditions grew in vitro after a latency period of 2 weeks. Since interleukin-6 (IL-6) induces final differentiation of activated B-lymphocytes, the cell line was evaluated for the presence of IL-6 receptors and biologic response to IL-6.

RESULTS

An Epstein-Barr virus (EBV)-negative cell line (UoC-B2) was established which expressed CD34, CD45, HLA-DR, CD19, CD20, sIgM, sIgD, and lambda light chain. Good general concordance was observed between the patient's lymphoma and the cell line by comparing the immunophenotype, genotype, and karyotype. The UoC-B2 cells expressed surface IgM but did not secrete IgM into the culture media even in the presence of supplemental IL-6.

CONCLUSIONS

A B-lymphoid cell line (UoC-B2) was established from a child with primary cutaneous lymphoma. The cells expressed cell surface IgM and receptors for IL-6 but supplemental IL-6 had no effect on IgM production or cell proliferation.

Large-cell lymphoma presenting with a distinctive inflammatory dermatosis

Severe, progressively enlarging inflammatory plaques of the upper trunk and neck developed in a 12-year-old girl. Histologic examination revealed a unique inflammatory cell infiltrate that consisted of chronic inflammation in the dermis subtending spongiosis with a diffuse neutrophilic epidermal infiltrate. A tumor in the right axilla was found by computed tomography. Tissue obtained at open biopsy examination demonstrated a large-cell lymphoma of B-cell origin. The tumor and dermatosis responded dramatically to chemotherapy. The distinctive histologic pattern and clinical course suggest that this dermatosis may represent an unusual paraneoplastic presentation of large-cell lymphoma.

B-cell differentiation pattern of cutaneous lymphomas in infancy and childhood

This article documents four children with cutaneous lymphomas. Two of them had regional disease and the other two already had disseminated disease when they were diagnosed. Immunophenotyping of the lymphomatous infiltration disclosed a cell antigen profile with pre-pre-B (HLA-DR+, CALLA+, VIB-C5+), pre-B (HLADR+, CALLA+, VIB-C5+, cytoplasmatic immunoglobulin+), and transitional pre-B characteristics (HLA-DR+, CALLA+, VIB-C5+, surface immunoglobulin+). The morphology of the blast cells in all patients showed features of lymphoblastic lymphoma. Two patients had the convoluted cell type in common, but they were immunologically different, one displaying pre-pre-B and the other pre-B immunophenotypes. The remaining two cases were diagnosed as lymphoblastic lymphomas "type others" according to the Kiel Classification, one with pre-B and the other with transitional pre-B characteristics. The morphologic and immunohistochemical parameters as well as the clinical data from the four cases clearly indicate the heterogeneity of cutaneous non-Hodgkin's lymphomas in children.