Charavin-Cocuzza M, Templier I, Simon A, Salameire D, Cuchet E, Reymond J-L, Beani J-C, Leccia M-T
Pôle pluridisciplinaire de médecine, service de dermatologie, CHU Albert-Michallon, BP 217, 38043 Grenoble cedex 09, France.
Ann Dermatol Venereol. 2008 Dec;135(12):848-51. doi: 10.1016/j.annder.2007.11.038. Epub 2008 Aug 29.
Secondary skin sites of lymphoma appear in the advanced stages of the disease. We report the first case of a pericicatricial skin infiltration, mimicking febrile dermohypodermitis, revealing diffuse immunoblastic large B-cell non-Hodgkin's lymphoma.
Four months after decompressive cervical laminectomy, a 56-year-old man presented an inflammatory pericicatricial patch evoking cellulitis in a setting of hyperthermia and lymphadenopathy. Blood cultures and bacteriological analysis of skin biopsy samples were negative. The images showed infiltration of the soft subcutaneous areas and polyadenopathy. Two weeks later, several subcutaneous nodules appeared on the trunk. Histological analysis and immunolabelling pointed to immunoblastic large B-cell non-Hodgkin's lymphoma. A clone of B lymphocytes CD45+, CD20+, CD79a+, Bcl2+, CD5+, MUM1+, CD3-, CD10-, CD23- and Bcl6- was seen. The remainder of the extension examination was negative. CHOP-rituximab polychemotherapy resulted in complete regression of all lesions, notably the inflammatory cervical plaque.
Secondary skin manifestations of lymphoma are generally non-specific (pruritus, ichthyosis, purpura, etc.) rather than specific in terms of lymphoid infiltration. As in our patient, certain cutaneous sites of lymphoma may have a misleading clinical presentation, histological analysis alone was able to provide a conclusive diagnosis. In our patient, the highly specific infiltration seen around the entire scar could either suggest a Koebner phenomenon or point to a role of the cutaneous aggression within the development of an inflammatory process contributing to pericicatricial infiltration by lymphoid cells. Locoregional invasion from the osseous part of the cervical spine and not macroscopically diagnosed during neurosurgery could also be responsible.
淋巴瘤的继发性皮肤病变出现在疾病晚期。我们报告首例瘢痕周围皮肤浸润病例，该病例酷似发热性真皮皮下炎，结果确诊为弥漫性免疫母细胞性大B细胞非霍奇金淋巴瘤。
一名56岁男性在颈椎减压性椎板切除术后4个月，出现一个炎症性瘢痕周围斑块，伴有高热和淋巴结病，疑似蜂窝织炎。血培养及皮肤活检样本的细菌学分析均为阴性。影像学检查显示皮下软组织浸润及多处淋巴结肿大。两周后，躯干出现多个皮下结节。组织学分析及免疫标记显示为免疫母细胞性大B细胞非霍奇金淋巴瘤。可见一个B淋巴细胞克隆，其表达CD45+、CD20+、CD79a+、Bcl2+、CD5+、MUM1+，不表达CD3-、CD10-、CD23-及Bcl6-。其余扩展检查均为阴性。CHOP-利妥昔单抗联合化疗使所有病变完全消退，尤其是颈部炎性斑块。
淋巴瘤的继发性皮肤表现通常不具有特异性（瘙痒、鱼鳞病、紫癜等），而非特异性的淋巴浸润表现。就像我们的患者一样，淋巴瘤的某些皮肤部位可能具有误导性的临床表现，仅靠组织学分析就能做出明确诊断。在我们的患者中，整个瘢痕周围出现的高度特异性浸润可能提示同形反应，或者表明皮肤损伤在炎症过程发展中起作用，促使淋巴样细胞发生瘢痕周围浸润。也可能是来自颈椎骨部分的局部侵犯，而在神经外科手术中未被宏观诊断出来。
