Large B-cell lymphoma of the leg: clinical and pathologic characteristics in a North American series.
BACKGROUND
Large B-cell lymphoma (LBCL) of the leg is an uncommon subset of primary cutaneous B-cell lymphoma that has been described in a series of European patients.


OBJECTIVE
Our purpose was to evaluate the clinical manifestation, diagnostic histopathology, immunophenotype, clinical course, and response to treatment of LBCL of the leg.


METHODS
We conducted a retrospective case series of 3 patients with primary LBCL of the leg.


RESULTS
The 3 elderly patients presented with progressive erythematous nodules on bilateral or unilateral lower extremities. All 3 patients had pre-existing peripheral edema or peripheral vascular disease. Histopathologic examination of the nodules showed dense lymphocytic infiltrates composed predominantly of large dysplastic lymphocytes that marked as B cells (CD20(+)). In 2 cases, the neoplastic cells were BCL-2 positive. All patients responded to initial therapy with localized electron beam radiation and chemotherapy but had disease progression. One patient had a complete and durable second response to anti-CD20 monoclonal antibody (rituximab).


CONCLUSIONS
The patients described have similar clinical and histopathologic features to those previously described. There may be an association between LBCL and pre-existing lower-extremity vascular disease. Treatment of LBCL is difficult, but 1 patient responded well to systemic anti-CD20 monoclonal antibody.
Brogan
Beth L
BL
Departments of Medicine, Vanderbilt University Medical School, Nashville, Tennessee 37232-5227, USA.
Zic
John A
JA
Kinney
Marsha C
MC
Hu
Judy Y
JY
Hamilton
Katherine S
KS
Greer
John P
JP
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007866:Leg / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D012189:Retrospective Studies; D000069283:Rituximab; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab