Dermatopathology Section, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Indian J Dermatol Venereol Leprol. 2011 May-Jun;77(3):314-7. doi: 10.4103/0378-6323.79702.
Primary cutaneous malignancies arising in association with chronic lymphocytic leukemia (CLL) are notable for their atypical clinical and histological presentation. We report a 69-year-old man with a 17-year history of CLL who presented for evaluation of a well-defined red to violaceous nodule with a central depressed scar on the left lower extremity. Microscopic examination of a punch biopsy revealed an infiltrate of predominantly small lymphocytes with scattered large, atypical epithelioid cells. Immunohistochemical stains revealed diffuse positive staining of the lesional cells with CD20+ and bcl-6+ and focal positive staining with bcl-2+ (negative CD10 and CD23), findings which, in conjunction with the histology, were most compatible with a diagnosis of primary cutaneous follicle center lymphoma (PCFCL). A review of the clinical charts revealed several prior biopsies with varied diagnoses. In light of the most recent biopsy findings, all previous biopsies were re-reviewed and interpreted as PCFCL arising in the setting of CLL. Features contributing to the diagnostic conundrum in this case included an atypical clinical and histological presentation, lack of pertinent clinical history and multiple presentations at different institutions.
原发于慢性淋巴细胞白血病（CLL）的皮肤恶性肿瘤以其非典型的临床和组织学表现而引人注目。我们报告了一例 69 岁男性，患有 CLL 病史 17 年，左下肢出现一个界限清楚的红色至紫红色结节，中央凹陷有瘢痕。活检的显微镜检查显示，主要由小淋巴细胞浸润，伴有散在的大、不典型上皮样细胞。免疫组化染色显示病变细胞弥漫阳性表达 CD20+和 bcl-6+，局灶性阳性表达 bcl-2+（CD10 和 CD23 阴性），这些发现结合组织学，最符合原发性皮肤滤泡中心淋巴瘤（PCFCL）的诊断。对临床病历的回顾显示，之前有几次活检，诊断各不相同。鉴于最近的活检结果，重新审查并解释了所有之前的活检，均为 CLL 背景下发生的 PCFCL。导致该病例诊断难题的特征包括非典型的临床和组织学表现、缺乏相关临床病史以及在不同机构的多次就诊。
