Spontaneous regression of primary cutaneous diffuse large B-cell lymphoma, leg type with significant T-cell immune response

Diffuse Large B-Cell Lymphoma Presenting Primarily as a Cutaneous Leg Lesion: A Case Report and Literature Review

Primary cutaneous B-cell lymphoma (PCBCL) has three subtypes, among those, the leg type variant is the rarest with the highest rates of relapse and recurrence making it an intriguing focus for researchers. Nevertheless, prior to framing a diagnosis solely based on the lesion's location, it is prudent to reconsider whether it is genuinely a primary cutaneous B-cell lymphoma (PCBCL) or if it aligns more closely with the more prevalent lymphoma variants such as diffuse large B-cell lymphoma (DLBCL) with cutaneous involvement. We are reporting a case of an 85-year-old African American lady, who presented with unilateral left leg DLBCL with cutaneous involvement. The patient was treated for recurrent cellulitis that was non-responsive to antibiotics; this prompted evaluation by leg MRI, which revealed a mass-like lesion involving the skin and muscle. Additional workup, which included tissue diagnosis and immunohistochemistry (IHC) studies, confirmed the diagnosis of DLBCL. A thorough clinical, laboratory, and imaging workup revealed diffuse meningeal lymphomatous involvement on brain MRI. The patient was started on reduced-intensity rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-mini-CHOP) protocol with granulocyte-colony stimulating factor (G-CSF) and showed a good initial response. This case highlights the importance of comprehensive evaluation in distinguishing primary cutaneous B-cell lymphomas from other variants, particularly in atypical presentations such as diffuse involvement.

Spontaneous regression of primary cutaneous diffuse large B-cell lymphoma, leg type: A case series and review of the literature

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is a subtype of cutaneous B-cell lymphoma with unfavorable prognosis usually requiring aggressive polychemotherapy for disease control. Only single cases of spontaneous regression of PCDLBCL, LT are reported in the literature, peaking 3 months post-biopsy following a clinical history of no longer than 1 year. Here, we report the first case of a spontaneously relapsing and remitting PCDLBCL, LT with complete regression after a clinical history of more than 9 years and thus an atypically indolent clinical course. The female patient presented with recurrent erythematous, non-ulcerated, non-raised plaques of the right lower leg for 6 years. Pathological workup and exclusion of a systemic disease confirmed the diagnosis of PCDLBCL, LT. Due to the history of repeated spontaneous remission, no therapy was initiated. Nine years after first occurrence the patient presented with complete clinical remission lasting for 64 months. We retrospectively identified four additional PCDLBCL, LT patients with spontaneous remission lasting up to 53 months. Our data provide evidence for a distinct PCDLBCL, LT patient subgroup that clinicians should be aware of and warrants a watch-and-wait treatment regime.

Spontaneous Regression of Primary Cutaneous Diffuse Large B-Cell Lymphoma on Sequential FDG PET

ABSTRACT

Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare, aggressive lymphoma characterized by skin involvement predominantly in the lower extremities. We present a case of an elderly woman with pathology diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type with spontaneous regression without systematic therapy documented by sequential FDG PET scans and clinical follow-up.

Primary Cutaneous B-cell Lymphoma Leg-type Related to a Tumour Necrosis Factor Alpha Inhibitor

Abstract is missing (Short communication)

Radiotherapy as a Treatment Option for Local Disease Control in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type

BACKGROUND

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is an aggressive lymphoma variant. Anthracycline-based chemotherapy with rituximab is recommended as first-line treatment. Radiotherapy (RT) has been considered as a therapeutic option for local disease control in patients with solitary or localized lesions.

METHODS

We report the results of a retrospective analysis of PCDLBC, LT patients treated either with RT alone or with physician's decision as first-line treatment, aiming to assess disease progression and/or first recurrence in these treatment groups.

RESULTS

We retrospectively analyzed 20 patients treated either with RT alone (n = 8) or with investigator's choice treatment (n = 12), which included chemotherapy alone or combined with local therapy (RT and wide local excision). Complete response (CR) was achieved in 8 patients from the first group and 9 patients from the second group, with 1 treatment failure. Six patients treated with RT alone progressed with a median time to progression (TTP) of 12.5 months. In the second group, 5 patients progressed with a median TTP of 5.2 months. RT showed good local disease control in both groups without any skin relapses during the follow-up period.

CONCLUSION

RT as first-line monotherapy followed by watchful waiting did not significantly improve the overall risk of disease progression but resulted in good local disease control. After progression, RT could still easily be combined with systemic treatment. The strength of this analysis needs to be evaluated in a larger patient cohort.

Effectiveness of lenalidomide in relapsed primary cutaneous diffuse large B-cell lymphoma, leg type

The primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) has a poor prognosis. R-CHOP with or without radiotherapy is the available recommendations for first-line treatment. Relapses/refractory cases are frequent with no standardized therapeutic guidelines. Lenalidomide seems to be an excellent therapeutic option as a second-line treatment of relapsed PCDLBCL-LT.

Spontaneous regression of diffuse large B-cell lymphoma in the small intestine with multiple lymphadenopathy

Diffuse large B cell lymphoma (DLBCL) is classified as an aggressive lymphoma due to its poor prognosis regardless of the treatment. Almost all cases of DLBCL are treated using rituximab-combination chemotherapy, but spontaneous regression without any therapeutic modalities may rarely occur. A 35-year-old man complained of abdominal pain and discomfort. Positron emission tomography-computed tomography (PET-CT) demonstrated abnormal accumulation of fluorodeoxyglucose in the thickened wall of the small intestine and multiple lymphadenopathy. Laparoscopic lymph node biopsy was performed, and the diagnosis of DLBCL was made based on the biopsy findings. Soon after the laparoscopic biopsy, the patient felt free from any symptoms. Approximately three months later, no abnormal accumulation of fluorodeoxyglucose in the entire body was found on PET-CT. He has remained in complete metabolic remission for over three years according to PET-CT. We discuss the mechanism of this rare phenomenon.