[Splenic marginal zone B-cell lymphoma with epidermotropic skin involvement]

Area of Science:

• Hematology
• Oncology
• Dermatology

Background:

• Marginal zone B-cell lymphoma (MZL) is categorized into extranodal, splenic, and nodal subtypes.
• Cutaneous lymphomas are a subset of extranodal MZL.
• Splenic MZL typically involves the spleen, peripheral blood, and bone marrow.

Observation:

• A 68-year-old man presented with skin lesions indicative of MZL.
• Skin biopsy revealed epidermotropic lymphocytic infiltration, a rare finding for primary cutaneous MZL.
• The patient had concurrent splenic MZL, peripheral blood, and bone marrow involvement.

Findings:

• Splenectomy confirmed splenic MZL and resolved skin lesions.
• Cutaneous recurrence was treated with chemotherapy and rituximab.
• Hepatitis B virus reactivation occurred post-treatment, leading to fatal hepatitis.

Implications:

• Splenic MZL can present with cutaneous involvement and epidermotropism.
• Treatment strategies for splenic MZL require careful consideration of potential hepatitis B reactivation.
• Pre-treatment screening for hepatitis B is crucial for patients undergoing chemotherapy and rituximab therapy.