b cell lymphoma prognosis | Large-cell "leg-type" cutaneous b lymphoma on brûlureCutaneous large B-cell leg-type lymphoma occurring on a leg burn

Large-cell "leg-type" cutaneous b lymphoma on brûlureCutaneous large B-cell leg-type lymphoma occurring on a leg burn




Summary
Introduction
Primitive B cutaneous lymphomas form a heterogeneous group of lymphoid proliferations located in the skin. We report a case of primitive skin B lymphoma with large "leg type" cells, which appeared on the site of an old leg burn. Rare cases of cutaneous lymphoma developed on burn scar were described, but these were primitive cutaneous lymphomas of T phenotype.

Observation
A 85-year-old man had a history of burning the left leg 17 years earlier, treated by several grafts. It showed many ulcérobourgeonnantes lesions in the eyes of the scarred area. histological examination of a skin biopsy revealed the existence of large atypical lymphoid cells of immunoblastic or centroblastic morphology, of phenotype B in immunohistochemistry, in cutaneous ulceration, allowing the Diagnosis of B lymphoma with large cells. Lymphoma cells were also marked by MUM1/IRF4 and BCL2, lower by BCL6. They were not marked by CD10. The extension balance found only cortical lysis of the left tibia. Polychemotherapy by Cyclophosphamide, vincristine, and prednisone, in association with Rituximab, allowed for a transient initial regression.

Discussion
Our observation is original because it is a primitive skin B lymphoma with large cells, "leg type", developed on burn scar. Venous insufficiency or lymphatic stasis have already been implicated in the genesis of this type of lymphoma. Perhaps the trauma and an immune dysregulation at the site of the burn could also promote the development of this neoplasia.

Summary
Background
Primary cutaneous B-cell lymphomas form a heterogeneous group of lymphoid proliferations found on the skin. We report a case of primary leg-type cutaneous large B-cell lymphoma occurring on the site a previous leg burn. A Few rare cases of cutaneous lymphoma forming on burn scars have been described, but these concern primary cutaneous lymphomas of the T-cell phenotype.

Case Report
An 85-year-old man with a history of a burn to the left leg 17 years ago, previously treated with several skin grafts, presented numerous ulcerative budding lesions on the scar area. Histological examination of the skin biopsy revealed the existence in the skin ulcers of atypical large lymphoid cells having an immunoblastic or centroblastic morphology and shown by immunohistochemistry to be of the B-cell phenotype, thereby evoking a Diagnosis of large B-cell lymphoma. The lymphoma cells were positive for MUM1/IRF4 and BCL2, and more weakly for BCL6, but negative for CD10. The staging examination revealed only cortical lysis of the left tibia. Temporary initial regression was achieved by polychemotherapy including cyclophosphamide, vincristine and prednisone in combination with rituximab.

Discussion
This case is novel in that it involves primary large B-cell lymphoma, leg type, occurring on burn scar tissue. Venous insufficiency and lymphatic stasis have already been incriminated in the genesis of this type of lymphoma; The prior injury and resulting immune dysregulation at the burn site may have also contributed to the development of this neoplasia.