Images in Clinical Medicine
Cutaneous Lesions in Diffuse Large-B-Cell Lymphoma
N Engl J Med 1997; 336:1302May 1, 1997
- Article
Figure 1 A 65-year-old man was admitted to our hospital with fatigue, weight loss, night sweats, and multiple pruritic erythematous nodules and plaques on his left shoulder, one of which contained two central ulcers (Panel A). Physical examination revealed hepatosplenomegaly. The diagnosis of lymphoma, suggested initially by fine-needle aspiration biopsy of one of the skin lesions, was confirmed by immunohistochemical analysis of paraffin-embedded sections of a cervical lymph node. It showed positive staining of the tumor cells with CD20 and CD79a, two cell markers of a B-cell immunophenotype (Panel B, ×400), according to the alkaline phosphatase anti–alkaline phosphatase (APAAP) method. Clinical staging revealed the involvement of multiple abdominal and mediastinal lymph nodes. The patient was treated with a combination of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin. After one month of chemotherapy the cutaneous lesions and the degree of systemic lymphadenopathy were slightly reduced. After the third cycle of chemotherapy, severe pancytopenia developed that was resistant to treatment with hematopoietic growth factor (granulocyte–macrophage colony-stimulating factor), and the patient died.
Paolo Paredi, M.D.
University of MilanOreste Pierluigi, M.D.
Niguarda Hospital, 22100 Milan, Italy
