Track: Case Reports

Topic: Lymphoproliferative Disorders

Abstract:

A 42-year-old female was evaluated for asymptomatic subcutaneous nodules on the left scalp that had been present for four months. Initially, the patient was thought to have an epidermal inclusion cyst which was biopsied by an outside physician. She denied any history of lymphoma and systemic symptoms. A punch biopsy revealed B-cell lymphoma with follicle center features. Sections from the biopsy revealed a dense dermal lymphocytic infiltration with minor superficial and prominent deep distribution with extension to the subcutis. Immunohistochemical analysis confirmed an abnormal CD20+, CD10+, and BCL6+ B-cell infiltrate. Fluorescence In Situ Hybridization (FISH) studies were negative for t(14,18) translocation and identified chromosomal abnormalities involving chromosome 3 and chromosome 18. The overall features were compatible with primary cutaneous follicle center lymphoma (PCFCL). At her follow-up visit, the patient presented with a new subcutaneous nodule on the right cheek. A biopsy was performed, and this new lesion was found to be consistent with PCFCL. She was referred to radiation oncology for further evaluation and hematology/oncology for a bone marrow biopsy. A PET scan revealed no systemic involvement. PCFCL is a B-cell lymphoma that presents on the scalp, forehead, and trunk as grouped papules, plaques, or nodules. Histologically, PCFCL involves dermal and subcutaneous proliferation of centrocytes and centroblasts in a follicular pattern. Tumor cells express B-cell antigens (CD20 and CD79a) and do not have the t(14,18) translocation.¹ Importantly, our patient’s clinical presentation stresses the importance of prompt biopsy and microscopic examination of suspicious lesions since malignancies can resemble cutaneous cysts.

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Geetha Gowda, MS, BA