Related Experiment Videos
Cutaneous malakoplakia simulating relapsing malignant lymphoma
J P Palazzo1, D J Ellison, I E Garcia
1Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111.
Insights
This case report details a rare instance of cutaneous malakoplakia in a patient with diffuse large non-cleaved cell lymphoma. The condition presented unusually on the skin, despite systemic immunosuppression.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Malignant lymphoma, diffuse large non-cleaved cell type, can present with widespread lymph node involvement.
- Cutaneous malakoplakia is a rare condition typically affecting the urinary tract or gastrointestinal tract.
Observation:
- A 42-year-old male with lymphoma developed a non-regressing left groin mass, initially suspected as recurrent lymphoma.
- Skin biopsy revealed an ulcer and abscess with foamy histiocytes containing Michaelis-Gutmann bodies, characteristic of malakoplakia.
- Monocyte cultures exhibited ultrastructural features mirroring tissue findings, suggesting systemic monocyte-macrophage lineage involvement.
Findings:
- The patient presented with cutaneous malakoplakia in the left groin, an atypical site for this condition.
- Microscopic examination confirmed Michaelis-Gutmann bodies, indicative of malakoplakia, within a skin ulcer and abscess.
- Systemic involvement of the monocyte macrophage lineage was suggested by cultured peripheral blood monocytes.
Implications:
- This case highlights an unusual presentation of cutaneous malakoplakia in an immunocompromised lymphoma patient.
- The findings suggest a potential link between immunosuppression, lymphoma, and atypical malakoplakia development.
- Further research may elucidate the pathogenesis of malakoplakia in immunocompromised individuals.
Abstract:
This report describes the case of a 42-year-old man with malignant lymphoma, diffuse large non-cleaved cell type, who developed cutaneous malakoplakia in the left groin. The patient had widespread lymph node involvement, including a left inguinal mass which was clinically thought to represent recurrent lymphoma. The inguinal mass failed to regress after chemotherapy and irradiation, although lymphoma in other sites responded to chemotherapy. A skin biopsy of the area showed an ulcer and an abscess involving the dermis and subcutaneous tissue. Microscopically, a diffuse infiltrate of foamy histiocytes was seen with numerous intracellular and extracellular, round and laminated bodies. Some of these bodies had a "targetoid" appearance, stained strongly with von-Kossa's calcium stain and showed the typical appearance of Michaelis-Gutmann bodies by electron microscopy. Cultured monocytes from the peripheral blood of the patient showed ultrastructural features similar to their tissue counterparts, suggesting a systemic involvement of the monocyte macrophage lineage. This case represents an unusual presentation of malakoplakia of the skin associated with relapsing malignant lymphoma in a patient on immunosuppressive drugs.