Ahuja Sana, Malik Shaivy, Zaheer Sufian
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Int J Surg Case Rep. 2024 Oct;123:110298. doi: 10.1016/j.ijscr.2024.110298. Epub 2024 Sep 15.
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), known for its aggressive nature and tendency for extranodal extension. Extranodal involvement occurs in up to 40 % of cases, with primary lymphoma in soft tissue, particularly skeletal muscle, being exceedingly rare. This report presents a rare case of primary extranodal DLBCL in the calf muscle.
A 35-year-old man presented with an ulceroproliferative growth in left calf muscle, initially diagnosed as squamous cell carcinoma (SCC). Imaging studies, including CECT and MRI, were inconclusive, prompting a histological examination. Biopsy revealed large malignant cells with high mitotic activity, positive for LCA, CD20, BCL-2, MUM1, and CD10, confirming a diagnosis of primary extranodal DLBCL. The patient underwent resection followed by six cycles of chemotherapy (R-CHOP) and field radiation therapy. A follow-up PET showed significant improvement, with no evidence of disease recurrence.
DLBCL often presents with rapidly growing tumors in lymph nodes or extranodal sites. Primary skeletal muscle lymphoma, particularly of the DLBCL subtype, is extremely rare, constituting about 0.5 % of extranodal lymphomas. Diagnosis typically involves imaging and biopsy, with immunohistochemistry (IHC) being crucial for accurate classification and treatment planning.
DLBCL, while common among NHLs, rarely presents as primary extranodal lymphoma in skeletal muscle. The presented case underscores the importance of considering DLBCL in differential diagnoses for atypical soft tissue masses and the effectiveness of R-CHOP chemotherapy in managing this rare presentation. Prompt and appropriate treatment, such as R-CHOP chemotherapy, is essential for favorable outcomes.
弥漫性大B细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤（NHL）类型，以其侵袭性和结外扩散倾向而闻名。高达40%的病例会出现结外受累，而软组织，尤其是骨骼肌中的原发性淋巴瘤极为罕见。本报告介绍了一例发生在小腿肌肉的原发性结外DLBCL罕见病例。
一名35岁男性，左小腿肌肉出现溃疡性增生，最初被诊断为鳞状细胞癌（SCC）。包括CT增强扫描（CECT）和磁共振成像（MRI）在内的影像学检查结果不明确，促使进行组织学检查。活检显示有大量具有高有丝分裂活性的恶性细胞，LCA、CD20、BCL-2、MUM1和CD10呈阳性，确诊为原发性结外DLBCL。患者接受了手术切除，随后进行了六个周期的化疗（R-CHOP）和局部放射治疗。随访的正电子发射断层扫描（PET）显示有显著改善，无疾病复发迹象。
DLBCL通常表现为淋巴结或结外部位迅速生长的肿瘤。原发性骨骼肌淋巴瘤，尤其是DLBCL亚型，极为罕见，约占结外淋巴瘤的0.5%。诊断通常包括影像学检查和活检，免疫组织化学（IHC）对于准确分类和治疗计划至关重要。
DLBCL在NHL中虽常见，但很少以原发性结外淋巴瘤的形式出现在骨骼肌中。本病例强调了在非典型软组织肿块的鉴别诊断中考虑DLBCL的重要性，以及R-CHOP化疗在处理这种罕见表现中的有效性。及时且适当的治疗，如R-CHOP化疗，对于取得良好预后至关重要。
