Cendras J, Sparsa A, Bedane C, Delage M, Touati M, Bonnetblanc J-M
Service de Dermatologie, CHU Dupuytren, Limoges Cedex.
Ann Dermatol Venereol. 2007 Apr;134(4 Pt 1):357-61. doi: 10.1016/s0151-9638(07)89191-5.
Large B-cell lymphoma of the leg in elderly subjects, of intermediate prognosis according to the new EORTC classification, may present as nodular or ulcerated forms. There has been relatively little study of the various etiological hypotheses advanced, including venous insufficiency. We report the case of an elderly man with chronic leg ulcer, recently undergoing modification, in which microscopy revealed large B-cell lymphoma (CD20-).
A 78 year-old man presented chronic ulcer of the right leg of mixed origin with severe venous insufficiency and arteritis. In the previous 2 months, 2 nodules appeared in the centre of the ulcer. Histological examination of a skin biopsy revealed the presence of large B-cell lymphoma and immunohistochemical analysis showed positive anti-CD79a+, CD20- antibody labeling of cells. Staging studies showed only locoregional invasion. Because of the positive CD20- labeling, ZEM chemotherapy (idarubicine, cyclophosphamide, prednisolone) was given, resulting in disappearance of the nodules after four months and preliminary epidermal healing of the ulcer. Several months later, severe infectious complications necessitated amputation. Examination of the excised sample showed no residual tumor.
Many causal links have been proposed between large B-cell lymphoma of the leg and aetiologies such as infectious agents, Koebner phenomenon and chronic lymphedema, as well as various other vascular factors. A number of hypotheses were proposed in the present case. It may have been leg ulcer cutaneous B-cell lymphoma, or, more likely, development of lymphoma on a chronic mixed ulcer, with the respective roles of vascular disease, local immunosuppression and antigenic stimulation subject to debate.
根据欧洲癌症研究与治疗组织（EORTC）的新分类，老年患者腿部的大B细胞淋巴瘤预后中等，可表现为结节状或溃疡状。对于包括静脉功能不全在内的各种病因假说，相关研究相对较少。我们报告了一例患有慢性腿部溃疡且近期溃疡情况发生变化的老年男性病例，其显微镜检查显示为大B细胞淋巴瘤（CD20阴性）。
一名78岁男性，患有起源复杂的右下肢慢性溃疡，伴有严重的静脉功能不全和动脉炎。在之前的两个月里，溃疡中央出现了两个结节。皮肤活检的组织学检查显示存在大B细胞淋巴瘤，免疫组化分析显示细胞抗CD79a阳性、CD20抗体标记阴性。分期检查仅显示局部区域侵犯。由于CD20标记阴性，给予了ZEM化疗（去甲柔红霉素、环磷酰胺、泼尼松龙），四个月后结节消失，溃疡初步实现表皮愈合。几个月后，严重的感染并发症导致需要截肢。对切除样本的检查显示无残留肿瘤。
腿部大B细胞淋巴瘤与多种病因之间已提出了许多因果联系，如感染因子、科布内现象和慢性淋巴水肿，以及各种其他血管因素。本病例提出了一些假说。可能是腿部溃疡皮肤B细胞淋巴瘤，或者更有可能是在慢性混合性溃疡基础上发生淋巴瘤，血管疾病、局部免疫抑制和抗原刺激各自的作用仍存在争议。
