Abstract
A 42-year-old active duty male was referred to the dermatology clinic for persistent lesions on the back for almost a year. He believed they were from bug bites which never resolved. He vaguely reported a similar lesion 9 years prior which had been diagnosed as a reactive lymphoproliferative process and was surgically treated. He denied associated symptoms. On physical examination, he had a few well-demarcated, ovoid, dome-shaped, smooth pink plaques present on the upper and lower left back. A 4 mm punch biopsy to the center of two lesions were obtained. Hematoxylin and eosin stained sections revealed a diffuse, superficial and deep proliferation of histiocytes and predominantly small monomorphic lymphocytes with an abundant plasma cell component. The lymphocytes showed significant collagen trapping and occasional poorly formed germinal centers. Immunohistochemical stains showed mixed CD3 and CD20 positivity. BCL-6 and CD21 marked a subset of scattered larger lymphocytes in disrupted follicles. Cyclin D1 and CD10 were negative. Kappa and Lambda marked an extensive lambda-restricted plasma cell population. MYD88 mutation was obtained as lymphoplasmacytic lymphoma was considered in the differential, which was negative. Given the clinical and histological findings the diagnosis was most consistent with marginal cell lymphoma (MCL). While cutaneous MCL is thought to have an indolent course, it is important to determine if there is systemic involvement as cutaneous findings may be an initial manifestation. Primary cutaneous MCL is considered an indolent condition with excellent prognosis. However, patients with multiple sites of involvement are unlikely to have sustained remission but dissemination from extracutaneous sites is rare. We present a rare case of cutaneous marginal zone lymphoma and discuss its indolent course and interdisciplinary work-up. Clinical and histological images, along with clinical follow-up and treatment will be presented.
Financial Disclosure:
No current or relevant financial relationships exist.
