diffuse large cell lymphoma | B-cell lymphoma cutaneous diffuse large cell type lower limb

B-cell lymphoma cutaneous diffuse large cell type lower limb


Introduction
Lymphomas B diffuse large cell (LBDGC) skin of lower limb type occur preferentially in women after age 70 and Electively affect the lower limbs. They realize often multiple tumors, increasing volume, red purplish, localized or scattered.

Observation
A patient than 75 years without antecedent consults for the appearance of nodules under skin vehicles hard and painless moving for a month without associated General signs (night sweat, no weight loss or fever), at the level of the trunk, the back, neck,. arms. Only palpation allows to objectify these nodules as next skin is normal and dermo-hypodermic deep location. There is no Lymphadenopathy in the exam. A first biopsy excision of a nodule of the arm reveals a deep dermal localization of a B-cell lymphoma diffuse large cell, CD20 +, + Bcl2, Bcl6 +, CD10−, CD5−. The nodule biopsy was completely involved a month later. Again, the diagnosis is confirmed on a second specimen at the level of the neck. The assessment of extension by TEP found multiple Nodular homes under skin of the trunk and the root of the lower limbs associated with a hypermetabolic iliac adenopathy right. The myelogram is an over-representation of the compatible with a lymphoid hemopathy non myeloid contingent and the BOM is not spinal cord encroachment.

Discussion
Our cases of Cutaneous Lymphoma is atypical in its presentation (nodules not visible to the naked eye) and location (essentially the trunk). The involution of the nodules is classic but rare. We have kept the diagnosis of lymphoma cutaneous B primitive as the only regained adenopathy corresponds to the territory of drainage of the nodules under skin of the root of the lower limbs. Indeed the Nosological difference between a ganglionic LBDGC with cutaneous localization and a primitively skin LBDGC is based on a negative extension to the diagnosis for primitively Cutaneous Lymphoma. However their prognosis is different: the primitively cutaneous form has a prognosis intermediate, less aggressive than ganglion forms but the prognosis worsened because of their occurrence in older subjects [1]. Similarly, the seat of the lesions is a prognostic factor, specific to 3 years survival rate is 77% in the case of tumors does not affect the lower limbs (against 43% for the lower limbs) [2]. The prognosis is related the ganglionic dissemination or visceral (brain in particular) but also responsible for skin progress of an alteration of the general State or septic complications. However these factors don't impact treatment [1] which remains the same in both cases: RCHOP chemotherapy in first-line in the absence of co-morbidity. Treatment initiated in this patient with an excellent clinical and morphological response after 3 cures (disappearance of metabolic homes under skin and ganglion).

Conclusion
Clinical descriptions of lymphomas B diffuse large cell skin of lower limb type are quite stereotyped, but our case illustrates the sometimes atypical manifestations in terms of presentation and location. Despite differences with the ganglionic B Lymphoma in Nosological terms, the treatment remains the same.