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Al Harbi SM, Al Ghamdi NJ, Elsharkawy TM, Al Hamad MA, Bajawi S. Primary Cutaneous T-Cell/Histiocyte-Rich B-Cell Lymphoma: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:309-316. [PMID: 36756220 PMCID: PMC9900238 DOI: 10.2147/ccid.s395675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is a lymphoproliferative disorder in which the majority of cells are reactive T cells with only a minor population of neoplastic large B cells. THRLBCL is a very rare lymphoma, and most cases are nodal THRLBCL; an extranodal case of THRLBCL presenting primarily on the skin is an extremely rare occurrence with only a few cases reported in the literature. Here, we report a case of a primary cutaneous THRLBCL in a 41-year-old Saudi male who presented unusually with multiple skin lesions. He was successfully treated with electron beam radiotherapy and had a complete resolution with no recurrence as of his 24-month follow-up.
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Affiliation(s)
- Sadan Mohammed Al Harbi
- Department of Dermatology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia,Correspondence: Sadan Mohammed Al Harbi, Department of Dermatology, College of Medicine, Imam Abdulrahman Bin Faisal University, Post Box No. 1982, Dammam, 31441, Saudi Arabia, Email
| | - Nada Jomaan Al Ghamdi
- Department of Dermatology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Tarek Mohamed Elsharkawy
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Mohammad Abdelqader Al Hamad
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Sultan Bajawi
- Department of Dermatology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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Vezzoli P, Fiorani R, Girgenti V, Fanoni D, Tavecchio S, Balice Y, Mozzana R, Crosti C, Berti E. Cutaneous T-cell/histiocyte-rich B-cell lymphoma: a case report and review of the literature. Dermatology 2011; 222:225-30. [PMID: 21540569 DOI: 10.1159/000327376] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/09/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) primarily presenting on the skin is an extremely rare entity with only sporadic cases reported in the literature. METHODS We here report an extraordinary case of primary cutaneous THRLBCL with self-healing and 24 months of follow-up. RESULTS The lesion was a dermohypodermal/subcutaneous circumscribed ulcerated nodosity. Histological examination with immunohistochemical, molecular analysis and comparative genomic hybridization were performed. A complete staging was negative for secondary involvement. CONCLUSION Our case is remarkable because it is the second well-documented primary cutaneous THRLBCL in which we observed a complete self-regression of skin lesions without recurrences or dissemination of the disease. According to the literature, we highlight that the tumoral microenvironment, in our case, could play a relevant role in stopping lymphoma growth. Furthermore, this case supports the observation that THRLBCL primarily presenting on the skin shows an overall good prognosis.
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Affiliation(s)
- Pamela Vezzoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.
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Bagwan IN, Knee G, Abboudi Z, Naresh KN. Small intestinal presentation of nodular lymphocyte-predominant Hodgkin lymphoma with T cell/histiocyte-rich B cell lymphoma-like areas-with review of literature on extranodal presentation of this disease. J Hematop 2010; 3:29-34. [PMID: 21436871 DOI: 10.1007/s12308-010-0056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/28/2010] [Indexed: 10/19/2022] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), accounts for ∼5% of all cases of Hodgkin lymphoma and is characterized by involvement of the peripheral lymph nodes. NLPHL occurs in young adults and is associated with frequent relapses. In 3% to 7% of cases, NLPHL progresses to a diffuse large B cell lymphoma. Furthermore, a proportion of NLPHL also have areas with features of T cell/histiocyte-rich large B cell lymphoma (THRLBCL), either at presentation or on follow-up. Here, we describe a 32-year-old man who presented to the emergency department with small bowel perforation. The resected small bowel showed full-thickness mural ulceration and involvement by a lymphoma with features of NLPHL that also had areas resembling THRLBCL. The patient had axillary lymphadenopathy, biopsy of which showed NLPHL with focal THRLBCL-like areas. Such a lymphoma presenting as small intestinal lesion/perforation has not been reported in the literature before. We take this opportunity to review the literature on extranodal presentations of NLPHL and discuss the natural history of this disease.
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Watabe H, Kawakami T, Soma Y, Baba T, Mizoguchi M. Primary cutaneous T-cell-rich B-cell lymphoma in a zosteriform distribution associated with Epstein-Barr virus infection. J Dermatol 2002; 29:748-53. [PMID: 12484440 DOI: 10.1111/j.1346-8138.2002.tb00215.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
T-cell-rich B-cell lymphoma (TRBL) is a lately recognized B-cell lymphoma variant characterized by a minor population of neoplastic B cells existing in a background of predominant polyclonal T cells. We report an 86-year-old man with primary cutaneous TRBL associated with Epstein-Barr (EB) virus infection. Clinically, palpable scaly erythemas were distributed in a zosteriform pattern on the right abdomen. Histologically, massive cellular infiltrates were located in the upper- and mid-dermis. Higher magnification showed that the cellular infiltration was composed mainly of abnormal mononuclear, large lymphoid cells with clear cytoplasm and scattered mitoses and small lymphocytes, which represented in excess of 75% of all the infiltrating cells. Immunohistochemical staining revealed that the large cells were positive for the B cell marker, CD20, but negative for the T cell marker, CD3. On the other hand, the small cells were positive for CD3, but negative for CD20. Polymerase chain reaction (PCR) revealed EB virus DNA in the skin lesion. Primary cutaneous TRBL has only been reported in 15 cases worldwide. To our knowledge, this is the first case of primary cutaneous TRBL in a zosteriform distribution reported in the literature and the second case of primary cutaneous TRBL associated with the EB virus infection. We postulate that the EB virus may be a contributory pathogenetic event leading to monoclonal B-cell proliferation.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD20/analysis
- Base Sequence
- Biopsy, Needle
- DNA, Viral/analysis
- Diagnosis, Differential
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/diagnosis
- Follow-Up Studies
- Herpes Zoster/diagnosis
- Humans
- Immunohistochemistry
- Lymphoma, T-Cell, Cutaneous/complications
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Molecular Sequence Data
- Polymerase Chain Reaction
- T-Lymphocytes/pathology
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Affiliation(s)
- Hidenori Watabe
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Li S, Griffin CA, Mann RB, Borowitz MJ. Primary cutaneous T-cell-rich B-cell lymphoma: clinically distinct from its nodal counterpart? Mod Pathol 2001; 14:10-3. [PMID: 11211304 DOI: 10.1038/modpathol.3880250] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cases of two patients with Stage IE primary cutaneous T-cell-rich B-cell lymphoma (TCRBCL) are described. In both, the lesion showed a dense infiltrate by numerous small T lymphocytes with scattered histiocytes and large atypical B-lymphoid cells. Polymerase chain reaction assays demonstrated that the B cells were monoclonal, with immunoglobulin heavy-chain gene rearrangement. No clonal rearrangements of the T-cell receptor gamma gene were observed. Both patients were disease-free at 4 months and at 5 years after therapy, respectively. Although rare, primary cutaneous T-cell-rich B-cell lymphoma appears to have a better prognosis than its nodal counterpart, with or without skin involvement.
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MESH Headings
- Antigens, CD20/analysis
- CD3 Complex/analysis
- Clone Cells
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Genes, T-Cell Receptor gamma/genetics
- Humans
- Immunoenzyme Techniques
- Immunoglobulin Heavy Chains/genetics
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/chemistry
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Skin Neoplasms/chemistry
- Skin Neoplasms/classification
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
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Affiliation(s)
- S Li
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Pandolfino TL, Siegel RS, Kuzel TM, Rosen ST, Guitart J. Primary cutaneous B-cell lymphoma: review and current concepts. J Clin Oncol 2000; 18:2152-68. [PMID: 10811681 DOI: 10.1200/jco.2000.18.10.2152] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Primary cutaneous B-cell lymphoma (PCBCL) has only recently been recognized as a distinct clinical entity. With the advent of improved immunophenotyping and immunogenotyping, increasing numbers of PCBCL cases are being diagnosed. However, there is much confusion regarding the classification, treatment, and prognosis of these patients. The purpose of this article is to review and analyze the available data to provide the clinician with a concise summary of the diagnosis, prognosis, and treatment of PCBCL. DESIGN We conducted a thorough review of the medical literature on PCBCL, with a focus on classification, prognosis, and treatment trials. RESULTS AND CONCLUSION PCBCL is defined as a B-cell lymphoma originating in the skin. There is no evidence of extracutaneous disease at presentation and for 6 months after diagnosis, as assessed by adequate staging procedures. Currently, the European Organization for Research and Treatment of Cancer classification is the most concise disease classification scheme, dividing the subtypes of PCBCL by clinical behavior and histopathologic findings. Based on this classification, the most common subtype of PCBCL is follicular center cell lymphoma. PCBCL is generally an indolent form of lymphoma with a good prognosis. Although local cutaneous recurrences are observed in 25% to 68% of patients, dissemination to internal organs is rare. Five-year survival rates typically range from 89% to 96%. A specific subtype, large B-cell lymphoma of the leg, is noted to have a poorer prognosis, with a 5-year survival rate of 58%. Overly aggressive treatment of PCBCL has not been shown to improve survival or prevent relapse. The treatment of choice usually varies depending on the type of PCBCL, the body surface area, and the location of the involvement, as well as the age and general health condition of the patient. The majority of studies indicate that PCBCL is highly responsive to radiation therapy. Polychemotherapy should be reserved for involvement of noncontiguous anatomic sites or those with extracutaneous spread.
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Affiliation(s)
- T L Pandolfino
- Department of Medicine, Section of Hematology and Oncology, Northwestern University Medical School, Chicago, IL 60611, USA
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Dunphy CH, Nahass GT. Primary cutaneous T-cell-rich B-cell lymphomas with flow cytometric immunophenotypic findings. Report of 3 cases and review of the literature. Arch Pathol Lab Med 1999; 123:1236-40. [PMID: 10583929 DOI: 10.5858/1999-123-1236-pctcrb] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary cutaneous T-cell-rich B-cell lymphoma is a relatively rare entity that has been diagnosed most commonly using immunohistochemical and molecular techniques. Flow cytometric immunophenotyping (FCI) has not been described in this entity. We report the demonstration of B-cell monoclonality by FCI in 3 cases of primary cutaneous T-cell-rich B-cell lymphoma. METHODS Clinical and pathologic data were recorded for 3 cases of primary cutaneous T-cell-rich B-cell lymphoma. Immunohistochemical and FCI data were available in all cases; DNA analysis was performed in 1 case. RESULTS Flow cytometric immunophenotyping revealed a monoclonal B-cell population exclusively in the monocyte (large cell) region in all 3 cases. Immunohistochemistry confirmed the T-cell richness of the infiltrates within the cutaneous lymphomas; T cells accounted for 65% to greater than 90% of the cells within the infiltrates. DNA analysis by polymerase chain reaction in 1 case did not demonstrate a monoclonal rearrangement of the immunoglobulin heavy-chain gene. CONCLUSIONS Flow cytometric immunophenotyping in primary cutaneous T-cell-rich B-cell lymphoma may be useful in demonstrating monoclonality in these cases, especially if there is selective gating on the relatively small population of cells in the large cell region. The FCI data should be correlated with histology and immunohistochemistry.
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Affiliation(s)
- C H Dunphy
- Division of Hematopathology, Department of Pathology, St Louis University Health Sciences Center, MO 63104, USA
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Abstract
The classification of cutaneous lymphoma is a contentious issue. In this short review the merits of REAL classification and EORTC classification for cutaneous lymphoproliferative disease are examined. Points of terminological confusion between the two schemes are considered and a brief account of less common or ambiguous lymphoma types is provided.
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Affiliation(s)
- A J Norton
- Department of Histopathology and Morbid Anatomy, St. Bartholomew's, and the Royal London School of Medicine and Dentistry, St. Bartholomew's Hospital, West Smithfield, United Kingdom
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Bättig B, Mueller-Garamvoelgyi E, Cogliatti SB, Schmid U, Kappeler A, Cerny T, Laissue JA, Fey MF. T-cell-rich B-cell non-Hodgkin's lymphoma mimicking Hodgkin's disease. Leuk Lymphoma 1999; 33:393-8. [PMID: 10221522 DOI: 10.3109/10428199909058442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report on a patient with recurrent T-cell-rich B-cell lymphoma (TCRBCL), initially misdiagnosed as a lymphocyte-rich Hodgkin's disease. This case exemplifies the diagnostic problems of TCRBCL and the need for immunophenotypic analysis to differentiate TCRBCL from Hodgkin's disease, nodular paragranuloma and peripheral T-cell lymphoma. A rather unusual aspect is the long disease-free interval between the excision of the node in and the late relapse in 1996. The significance of the abundant T-cell infiltration in this B-cell neoplasm will be discussed and the concepts concerning antitumor response will be reviewed. Based on epidemiological data and the clinical behaviour TCRBCL does not seem to represent a distinctive pathological entity.
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Affiliation(s)
- B Bättig
- Institute of Medical Oncology, Inselspital, University of Berne, Switzerland
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Sander CA, Kaudewitz P, Kutzner H, Simon M, Schirren CG, Sioutos N, Cossman J, Plewig G, Kind P, Jaffe ES. T-cell-rich B-cell lymphoma presenting in skin. A clinicopathologic analysis of six cases. J Cutan Pathol 1996; 23:101-8. [PMID: 8721443 DOI: 10.1111/j.1600-0560.1996.tb01282.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We reviewed our experience with six T-cell-rich B-cell lymphomas (TRBL) presenting in skin. Immunohistochemical studies were performed on all biopsies. The lymphoid population consisted mainly of CD3 and/or UCHL-1 (CD45RO) positive T cells. 5 to 15% of the lymphoid cells stained for the B-cell marker L26 (CD20). Monoclonality of the B-cell component was demonstrated in all cases, utilizing either light chain restriction (5 cases) or clonal immunoglobulin heavy chain gene rearrangement by polymerase chain reaction (PCR) (2 cases). One case was confirmed to be monoclonal by both techniques. Additionally, no clonal rearrangements of the T-cell receptor gamma gene were observed. There was considerable morphological variety in these cases. In H&E stained sections, the differential diagnosis included pseudolymphoma, peripheral T-cell lymphoma, Hodgkin's disease, Lennert's lymphoma and a MALT lymphoma. A significant component of monoclonal plasma cells was present in 3 of 6 cases, suggesting a possible origin from cutaneous immunocytoma. In fact, one of our cases was a biphasic lymphoma displaying TRBL with a small focus of immunocytoma. We conclude that immunophenotypic analysis is necessary for the diagnosis of TRBL. Pathologists should be aware of this type of cutaneous B-cell lymphoma to avoid misinterpretation as a pseudolymphoma.
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Affiliation(s)
- C A Sander
- Department of Dermatology, LMU, Munich, Germany
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Yagi H, Ogai M, Izumi T, Ebihara T, Sugiura M, Tokura Y, Takigawa M. Cutaneous T-cell lymphoma with massive co-infiltration of polyclonal B cells. Br J Dermatol 1994; 130:226-30. [PMID: 7510123 DOI: 10.1111/j.1365-2133.1994.tb02905.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 76-year-old man presented with a 3-month history of a cutaneous nodule on the right thigh. The tumour was composed of CD3+, large atypical cells, and CD20+, small normal-appearing cells. Flow cytometry showed that CD20+ cells outnumbered CD3+ cells. By Southern blot hybridization analyses, the malignant cells were shown to be of T-cell origin, because of the presence of rearranged bands for the beta chain of the T-cell receptor, but not for the immunoglobulin heavy chain. This case represents a T-cell lymphoma intermingled with a large number of non-neoplastic B cells.
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Affiliation(s)
- H Yagi
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
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