Spontaneous Regression of Atypical Primary Cutaneous Diffuse Large B-Cell Lymphoma on Cheek upon Methotrexate Withdrawal

Case Report

Austin J Dermatolog. 2014;1(2): 1007.

Spontaneous Regression of Atypical Primary Cutaneous Diffuse Large B-Cell Lymphoma on Cheek upon Methotrexate Withdrawal

Seow Hoong Foo*, Evmorfia Ladoyanni and Indre Verpetinske

Department of Dermatology, Corbett Hospital, Dudley Group Hospitals NHS Foundation Trust, UK

*Corresponding author: Seow Hoong Foo, Dermatology Department, Corbett Hospital, Dudley Group Hospitals NHS Foundation Trust, Vicarage Road, Stourbridge, West Midlands, DY8 4JB, United Kingdom

Received: March 22, 2014; Accepted: May 05, 2014; Published: May 07, 2014

Abstract

Primary cutaneous diffuse large B–cell lymphoma (PCDLBCL) accounts for approximately 6% of all cutaneous lymphomas. PCDLBCL are usually seen in leg, however they can be seen in other location in 15% of cases.It usually affects elderly women and is associated with poor prognosis.Solitary lesions are relatively rare. The recommended treatment is as for systemic diffuse large B–cell lymphoma (DLBCL). We present an atypical case of PCDLBCL occurring on the cheek of an elderly woman and its spontaneous resolution upon withdrawal of methotrexate therapy for rheumatoid arthritis. It is paramount to recognise these cases and correlation being undertaken in order to avoid inappropriate chemotherapy.

Keywords: Primary cutaneous diffuse large B–cell lymphoma; Cheek; Methotrexate; Spontaneous resolution

Abbreviations

PCDLBCL: Primary Cutaneous Diffuse Large B–cell Lymphoma; PCBCL: Primary Cutaneous B– Cell Lymphoma

Background

Primary cutaneous diffuse large B–cell lymphoma (PCDLBCL) accounts for approximately 6% of all cutaneous lymphomas. PCDLBCL is usually seen in leg, however it can be seen in other location in 15% of cases [1]. It usually affects elderly women and its presentation is more commonly with multiple red or bluish–red nodules rather than solitary lesions.

When compared with other types of primary cutaneous B– Cell lymphoma (PCBCL), the prognosis of PCDLBCL is less favourable with a 5–year survival rate of approximately 20–50% [1]. Diagnosis is made by clinicopathological correlation, immunohistochemical findings, and molecular pathology.

When compared to the general population there is an excess risk of lymphoma in patients with chronic inflammatory polyarthritis on DMARDSs (disease modifying anti–rheumatic drugs) such as methotrexate [2]. We present the case of PCDLBCL occurring on the cheek of an elderly woman and its spontaneous resolution upon withdrawal of methotrexate therapy for rheumatoid arthritis. It is important that correlation is being undertaken in any case of atypical presentation of PCDLBCL in order to avoid inappropriate chemotherapy.

Case Presentation

A 78–year old woman presented to the dermatology department with a 5–week history of multiple erythematous nodules on left cheek (Figure 1). These nodules did not bleed and only caused mild itching occasionally. She was otherwise well in herself. She had suffered from moderate to severe rheumatoid arthritis for 25 years, which was controlled on combination therapy of methotrexate and sulfasalazine for the last 8 years. Clinical examination revealed multiple firm painless smooth erythematous nodules on left cheek, with the largest nodule being 1.5cm in diameter (Figure 1). There was no palpable lymphadenopathy or hepatosplenomegaly. An urgent skin biopsy was performed.

Citation: Foo SH, Ladoyanni E, Verpetinske I. Spontaneous Regression of Atypical Primary Cutaneous Diffuse Large B-Cell Lymphoma on Cheek upon Methotrexate Withdrawal. Austin J Dermatolog. 2014;1(2): 1007. ISSN:2381-9197