Diffuse large B cell lymphoma: cutaneous presentation

• Published in: BMJ case reports Vol. 11; no. 1; p. e226839
• Main Authors: Ferrão, Joana B, Barreira, João Vasco, Marote, Sara, Parmanande, Anuraj
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17.12.2018; BMJ Publishing Group
• Subjects: Case reports; Family medical history; Funding; Images In; Lymphoma; Medical prognosis; Patients; Skin; Skin cancer; skin cancer; malignant and benign haematology; haematology (incl blood transfusion)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-226839

On her physical examination, there was an extremely emaciated patient with a performance status Eastern Cooperative Oncology Group (ECOG) 4, presenting with multiple subcutaneous nodules distributed mainly through her upper body, the largest in size being the one on her right breast already with evidence of tissue necrosis and coexisting right axillary lymphadenopathies (figure 1). The presence of multiple skin lesions and time of evolution at presentation were associated with poorer prognosis in secondary cutaneous DLBCL.1–3 This case presenting with multiple nodular lesions is relevant for the extensive involvement of soft-tissue and individual nodule size that is not a characteristic seen as often as solitary erythematous nodule or erythematous-violaceous plaques.4 5 In the case, we chose to report despite the feasibility of treatment and this disease carrying a good prognosis with adequate chemotherapy, the performance status and large burden of disease of the patient have not allowed her to undergo adequate treatment for her disease. The first clinical sign of diffuse large B-cell lymphoma (DLBCL) is a quickly growing, non-painful mass, typically a lymph node in the neck, groin or abdomen, which may be accompanied with type B symptoms making this case an atypical presentation as for the initial absence of B symptoms but also the location of skin lesion.