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Unusual Clinicopathological Presentation of Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg type, With Multiple Nodules and Widespread Garland-like Lesions

Belousova, Irena E MD, PhD*; Vanecek, Tomas PhD; Skreg, Sergey V MD; Rodionov, Anatoly N MD, DrSc§; Samtsov, Alexey V MD, DrSc*; Kazakov, Dmitry V MD, PhD

The American Journal of Dermatopathology: June 2009 - Volume 31 - Issue 4 - p 370-374
doi: 10.1097/DAD.0b013e3181877a05
Extraordinary Case Report

We present a case of primary cutaneous diffuse large B-cell lymphoma, leg type, with an unusual clinical picture. A 41-year-old man presented with a 2-year history of slowly progressive plaques, nodules, and garland-like patches on his chest, right upper arm, and back. Complete staging investigations revealed no extracutaneous involvement. Histological examination of a nodule revealed a diffuse nonepidermotropic infiltrate mainly composed of large blast cells with features of immunoblasts and centroblasts and spindle cells seen at the periphery of the infiltrate. Histological examination of a garland-like lesion showed perivascular infiltrates composed predominantly of small lymphocytes admixed with only occasional large blasts. The blasts from the nodule and garland-like lesions and spindle cells identified in the nodule exhibited an identical phenotype: they stained positively for CD20, CD79a, and bcl-2 and tested negative for bcl-6, CD5, CD10, and TdT. CD35 revealed no networks of follicular dendritic cells. Widespread garland-like lesions are not a typical feature of primary cutaneous diffuse large B-cell lymphoma.

From the *Department of Dermatology and Venereology, Medical Military Academy, Saint-Petersburg, Russia; †Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic; ‡Department of Dermatology, Medical Academy of Postgraduating Education, Saint-Petersburg, Russia; and §Regional Dermatology and Venereology Center, Saint-Petersburg, Russia.

Reprints: Dmitry V. Kazakov, MD, Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.