An 88-year-old woman was evaluated for a 3-months history of asymptomatic nodules with progressive growth on the right leg. The patient did not report any constitucional symptoms or fever. Physical examination revealed a group of seven 4-cm nodules in the popliteal space of the right leg (Fig. 1) and two nodules of stony consistency with signs of lichenification on the anterior side of the leg (Fig. 2). Exploration was otherwise unremarkable. All haemato-chemical parameters were within the range of normal.
A skin biopsy taken from one of the posterior nodules showed a massive infiltration by malignant cells of lymphoid strain. Immunohistochemical study showed positivity for CD-20, CD-79, bcl-2 and MUM-1; CD-10 was negative.
A PET/CT was performed and showed multiple foci of high/intense metabolic activity with a multilobed morphology corresponding the subcutaneous tissue in the right lower extremity. In the remaining structures, radionuclide uptake followed a physiologic distribution. A diagnosis of primary cutaneous diffuse large B cell lymphoma (PCLBCL), leg type was made. A decision was made not to perform a bone marrow examination, due to the clinical status of the patient.
The patient began treatment with rituximab plus anthracycline-based combination chemotherapy regimen.
