Objectives: Hacer un abordaje sencillo y claro de las lesiones cutáneas en pacientes con neoplasias de base, pasando por sus simuladores y evaluando la epidemiología asociada a este tipo de hallazgos en piel.
Introduction: 66-year-old female patient, with history of diffuse large cell non-Hodgkin lymphoma, in treatment with R-CHOP therapy with an inadequate response. During her hospital stay, the patient was referred to dermatology consult due to a 3-day history of lesions in the anterior thorax associated with burning pain and pruritus. Upon physical exam, she presented with multiple erythematous and edematous plaques with irregular, well-defined edges who merged in the left parasternal region.
Materials / method: Herpes zoster was initially suspected, leading to IV acyclovir treatment due to her immunocompromised status. Because there was no satisfactory response, a skin biopsy was performed.
Pathology report showed the presence of an infiltrate with a neoplastic appearance that extended to the reticular dermis, lymphocytes with prominent nucleus, and a high mitotic rate. Immunohistochemistry with revealed a population of neoplastic cells which marked positive for common leukocyte antigen, CD20, BCL2, FOXP1 and MMU1 with Ki67 a 90% positivity.
Results: Diffuse large B-cell lymphoma (CBCL) is the most common type of B cell lymphoma, accounting for 30 to 50% of all non-Hodgkin lymphoma cases. However, its clinical manifestations on the skin are atypical and infrequent. Its presentation is aggressive and can be expressed in different clinical forms . It is more common in individuals older than 60 years as a novelty presentation or due to the transformation of small cell non-Hodgkin lymphoma . Its symptoms will depend on tumor location and up to 30% of cases can be associated with constitutional symptoms.
Conclusion: B-cell lymphoma is a frequently reported pathology, however; skin involvement is an infrequent manifestation and can easily be confused with other diseases. Its course is generally aggressive with a high burden of morbidity and mortality despite targeted and timely treatment.
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