Primary cutaneous follicle-center lymphoma

Area of Science:

• Dermatology
• Hematology
• Oncology

Background:

• Cutaneous B-cell lymphomas (CBCLs) present diagnostic challenges due to overlapping morphology with reactive conditions.
• Accurate diagnosis is crucial for appropriate patient management and treatment.

Observation:

• A 64-year-old man presented with a three-year history of pruritic facial papules and nodules.
• Biopsy revealed a clonal lymphoproliferative B-cell disease with a clonal IGH rearrangement.
• Clinicopathologic correlation, including lesion location and specific protein expression (bcl-2, MUM1), raised suspicion for cutaneous B-cell lymphoma over a reactive process.

Findings:

• Systemic work-up excluded disseminated disease, supporting a diagnosis of primary cutaneous follicle-center lymphoma (PCFCL).
• Treatment with systemic rituximab resulted in partial resolution of facial lesions.
• The case underscores the difficulties in diagnosing PCBCL, even with updated classification systems.

Implications:

• This case emphasizes the critical need for integrated clinical and pathological reasoning in diagnosing PCBCL.
• Individualized diagnostic and treatment approaches are necessary for suspected cutaneous B-cell lymphomas.
• Refined diagnostic criteria and correlation remain vital for managing rare B-cell lymphoproliferative disorders affecting the skin.