Cutaneous relapse in Hodgkin's disease

Extensive Extranodal Cutaneous Lymphomatous Involvement in a Case of Adult T-Cell Lymphoma - Advantage of 18F Fluorodeoxyglucose Positron-emission Tomography-Computed Tomography over Computed Tomography

Diffuse extranodal cutaneous lymphomatous involvement is a unique presentation in a case of adult T-cell lymphoma. We present the case of a 26-year-old female who presented with erythematous rashes with subsequent evaluation with 18F fluorodeoxyglucose positron-emission tomography-computed tomography showing enlarged inguinal and axillary lymph nodes, and biopsy findings from the inguinal lymph nodes were suggestive of adult T-cell lymphoma.

Diffuse large B cell lymphoma progression with skin involvement: A case report

Diffuse large B cell lymphoma (DLBCL) constitutes the most frequent subtype of all non-Hodgkin's lymphomas. DLBCL is an aggressive disease and extranodal involvement is seen in approximately 30% of patients and most common extranodal sites are gastointestinal tract and skin. Skin involvement may be either primary or secondary. Secondary cutaneous lymphoma has a worse prognosis. The case is here reported of a 56-year old male DLBCL patient with cutaneous lesions and aggressive clinical course. The patient had no skin lesions at diagnosis and during follow up and treatment period, skin, cerebrospinal fluid and bone marrow involvement was occurred. Salvage chemotherapy and autologous stem cell transplantation was planned but the patient died before the second cycle of salvage chemotherapy. In contrast to primary cutaneous lymphoma, which tends to be more indolent, secondary skin involvement is associated with unfavourable prognosis. In conclusion it should be kept in mind that skin can be involved in lymphoma patients and in these cases, skin biopsy should be performed rapidly.

Cutaneous extra nodal lymphoma relapse: A case report and review of literature

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Cutaneous lymphomas are the second most frequent site of extra nodal involvement.

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The majority of relapses occur within the first two years after completion of treatment.

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Relapses are frequently symptomatic.

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First line treatment for solitary lesions includes surgical excision, antibiotics and radiotherapy.

Introduction

Cutaneous lymphomas represent a unique group of lymphomas. Cutaneous lymphomas are the second most frequent extra nodal involvement; gastrointestinal involvement being the most frequent (Malkan et al. [1]).

To the best of our knowledge few cases of cutaneous relapse of Non-Hodgkin Lymphoma (NHL) have been reported where there was an absence of primary cutaneous involvement.

Case presentation

A case study of a 70-year-old woman who was referred for an excisional biopsy of a lesion on her left cheek in 2017.

She had previously been diagnosed with NHL in 2009; disease involved the right groin lymph nodes. The patient completed a course of chemotherapy and was in remission.

An excision of the lesion on the left upper cheek confirmed low-grade follicular lymphoma. A PET scan was performed after the histology from the lesion was confirmed which demonstrated moderate fluorodeoxyglucose (FDG) uptake in left cheek, left external iliac lymph nodes and left tonsil consistent with recurrence of lymphoma.

Discussion

The majority of relapses of NHL occur in the first 2 years after the completion of treatment. Extra nodal lymphomas comprise 24–48 percent of cases. The reason for multifocal extra nodal lymphoma or preferential involvement of specific extra nodal sites at recurrence is not clear

Extra nodal involvement involving skin accounts for 10 percent of cases.

NHL typically relapses in the same involvement sites.

First line treatment for solitary lesions includes surgical excision, antibiotics and radiotherapy.

Conclusion

Disease relapse was not present in the primary involvement site. Furthermore, there was a cutaneous relapse where there was no primary cutaneous disease. Treatment involved systemic therapy for this patient given the nodal involvement found on the PET scan.

Itching attacks with generalized hyperhydrosis as initial symptoms of Hodgkin's disease

BACKGROUND

Clinical signs of Hodgkin's disease are unexplained weight loss, nocturnal sweating, fever and more or less permanent itching or pain around the affected lymphnodes, especially after alcohol consumption. Paraneoplastic symptoms are major challenges to the dermatologist, particularly if these seem harmless, though somewhat strange, as in the following case.

OBSERVATION

A 35-year-old patient had suffered for about 6 months from paroxysmal severe itching. A transient, generalized hyperhydrosis followed these attacks closely. The itching attacks usually began between the fingers and on the palms of the hands, and then spread to become generalized over the entire integument. The itching attacks commonly occurred three times daily for only a few minutes, while the subsequent severe hyperhydrosis, with cold sweat, lasted up to an hour.

CONCLUSIONS

This case illustrates the necessity of considering a malignant underlying disease like Hodgkin's disease, not only in the presence of the well-known B-symptoms, but also when peculiar symptom combinations, like itching attacks and immediately subsequent transient generalized hyperhydrosis are present.