A Case of Transformation of Primary Cutaneous Follicle Center Lymphoma to Diffuse Large B-Cell Lymphoma Involving the Parotid Gland and Cervical Lymph Nodes
Challenging differential diagnosis, Rare co-existance of disease or pathology
Maurice L. King, Toms Vengaloor Thomas, Ashley A. Albert, Sanjay Joseph, Lakshmi Ramachandran Nair, John T. Lam, William C. Woods, Mary Nittala, Srinivasan Vijayakumar
(Department of Radiation Oncology, The University of Mississippi Medical Center, Jackson, MS, USA)
Am J Case Rep 2019; 20:1273-1278
Transformation of primary cutaneous follicle center lymphoma (PCFCL), a low-grade B-cell non-Hodgkin lymphoma (NHL), into a high-grade NHL is rare with uncertain prognosis and treatment. A case is reported of a 40-year-old man who presented with a scalp mass that was diagnosed histologically as PCFCL. Imaging of the head and neck identified diffuse large B-cell lymphoma (DLBCL) involving the parotid gland and cervical lymph nodes, which responded well to radiation therapy.
CASE REPORT: A 40-year-old African American man presented with a two-year history of a progressively enlarging scalp mass that measured 10.5×7.1×6.6 cm. Histology showed a low-grade lymphoma with a follicular pattern. Immunohistochemistry was positive for B-cell markers and Bcl-6, consistent with a diagnosis of PCFCL. Computed tomography (CT) identified a 4.9×3.7×3.4 cm mass in the left parotid gland with bilateral cervical lymphadenopathy that had been present for the previous two or three months. The diagnosis of DLBCL was made on histology from a needle biopsy. Treatment began with rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH) chemotherapy, followed by radiation therapy to the scalp, both sides of the neck, and left parotid gland. At four-month follow-up, combined positron emission tomography (PET) and CT showed only diffuse low-level uptake in the scalp and parotid gland.
CONCLUSIONS: Transformation of low-grade PCFCL to high-grade DLBCL is rare, and the approach to treatment varies. This case showed a good response to chemotherapy and radiation therapy.
Keywords: Lymphoma, Large B-Cell, Diffuse, Lymphoma, Non-Hodgkin, Lymphoma, Primary Cutaneous Anaplastic Large Cell