LY17 Bilateral presentation of primary cutaneous diffuse large B-cell lymphoma, leg type: a case series

Abstract

Primary cutaneous diffuse large B-cell lymphoma, leg type (DLBCL-LT) is uncommon, typically presenting with rapidly growing lower-limb bluish-red nodules. Bilateral limb involvement of cutaneous DLBCL-LT is infrequent. We present a short case series. Case 1: an 88-year-old woman presented with 2-month history of indurated purple–deep red nodules and plaques over both lower limbs. Diagnostic punch biopsy confirmed DLBCL-LT, and staging positron emission tomography (PET) scan showed several fluorodeoxyglucose (FDG)-avid foci in skin and subcutaneous tissue of the right ankle, as well as foci in the left calf and thigh. She was treated with single-modality radiotherapy (8 Gy in one fraction) per patient preference. Unfortunately, she died within 3 years from disseminated disease. Case 2: a 69 year-old man presented with a 3-month history of a rapidly growing left-leg nodule, confirmed histologically as DLBCL-LT following excision. He was treated with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) and adjuvant radiotherapy (30 Gy in 15 fractions) with excellent response. At 2 years, a new nodule on the right leg was excised, showing overlap of morphology and immunohistochemical staining with the previous specimen, in keeping with recurrent DLBCL-LT. He received radical radiotherapy (30 Gy in 15 fractions) and is disease free at 5 years. Case 3: an 80 year-old man presented with 3-month history of two nodules on the left ankle. Incisional biopsy confirmed DLBCL-LT and a baseline PET scan showed FDG-avid left-heel and circumferential lower-leg cutaneous lymphoma. He was treated with six cycles of R-CHOP and no adjuvant radiotherapy due to complete metabolic response on PET. Six weeks after completing treatment, he reported two new lesions on the right leg. Incisional biopsy demonstrated recurrence of DLBCL-LT and he started R-GemOx chemotherapy. He is currently under treatment 20 months after the initial presentation. These cases illustrate that bilateral primary cutaneous DLBCL-LT, while uncommon, reflects aggressive disease with a high risk of relapse and variable outcomes despite multimodal therapy.