title: Diffuse large B-cell lymphoma presenting as a chronic leg ulcer: the importance of repeat tissue biopsy.
abstract: Ulceration of the leg is often associated with significant consequences for both the individual and society. The diagnosis of chronic leg ulcer is not appropriate. Primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, is a distinct clinicopathological entity. Chemotherapy  in the form of R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) is considered to be the first line of treatment for these lymphomas. We report a 69-year-old man who presented with chronic leg ulcer with a first negative biopsy and a diagnosis of PCLBCL, leg  type, verified on the subsequent biopsy. This case report emphasises the importance of differential diagnosis of lymphoma in non-healing ulcers and also the value of repeat tissue biopsy in cases with a negative initial result but strong clinical suspicion.
authors.affiliation: Academic Vascular Surgical Unit, Hull Royal Infirmary, UK. junaid.khan@hey.nhs.uk
authors.forename: Junaid Alam
authors.initials: JA
authors.lastname: Khan
authors.forename: Farooq
authors.initials: F
authors.lastname: Usman
authors.forename: Shaista
authors.initials: S
authors.lastname: Abbasi
authors.forename: Syed Sulaiman
authors.initials: SS
authors.lastname: Shoab
mesh_terms: D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000473:pathology; D008297:Male; D019233:Retreatment; D012878:Skin Neoplasms / Q000150:complications* / Q000473:pathology