Cutaneous B-cell lymphoma with histologic features of mycosis fungoides.
Histologic examination of skin biopsy specimens from a 57-year-old man with a pruritic rash on his chest, abdomen, and thighs revealed a dense atypical dermal lymphoid infiltrate bordering the dermoepidermal junction and scattered intraepithelial lymphocytes. Histopathologic and clinical features were suggestive of mycosis fungoides. Immunophenotyping studies, however, identified CD20(+) B lymphocytes with aberrant expression of CD43. Clonal immunoglobulin gene rearrangement was demonstrated, and no clonal T-cell gene rearrangement was identified. Morphologic and immunophenotypic features were most consistent with extranodal marginal zone B-cell lymphoma. Systemic evaluation identified involvement of the bone marrow and possibly the peripheral blood, spleen, and splenic lymph nodes. Cutaneous manifestations were treated with narrowband ultraviolet B phototherapy for 3 months, resulting in complete resolution of the pruritus and rash. Primary and secondary cutaneous B-cell lymphomas seldom mimic mycosis fungoides histologically. Immunophenotyping studies were critical in correctly classifying this rare example of an epidermotropic B-cell lymphoma.
Chiang
Sarah
S
Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.
DiCaudo
David J
DJ
Valdez
Riccardo
R
Swanson
David L
DL
D001402:B-Lymphocytes / Q000528:radiation effects; D003937:Diagnosis, Differential; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008297:Male; D009182:Mycosis Fungoides / Q000175:diagnosis / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D014467:Ultraviolet Therapy