Primary cutaneous B-cell lymphoma and Borrelia burgdorferi infection in patients from the Highlands of Scotland

Although a link beteen primary cutaneous B-cell lymphoma (PCBCL) and Borrel ia burgdorferi infection has long been suspected, previous studies have not demonstrated a significant association. The authors looked for evidence of B. burgdorferi in 20 cases of PCBCL from the Scottish Highlands, an area w ith endemic Lyme disease, and compared their findings with those in 40 cont rol patients (20 undergoing wide reexcision at sites of malignant melanoma and 20 biopsies of inflammatory dermatoses). All studies were performed on formalin-fixed, paraffin-embedded tissues. The cases of PCBCL were classifi ed according to criteria described by the European Organization for Researc h and Treatment of Cancer Cutaneous Lymphoma Project Group using a combinat ion of morphology, immunohistochemistry, and seminested polymerase chain re action (PCR) for immunoglobulin heavy chain gene rearrangement. A nested PC R was performed on deoxyribonucleic acid (DNA) extracts from the lymphoma a nd control cases using primers to a unique conserved region of the B. burgd orferi flagellin gene. B. burgdorferi-specific DNA was detected in seven of 20 lymphoma cases (five of 12 marginal zone lymphomas, one of five primary cutaneous follicle center cell lymphomas, one of three diffuse, large B-ce ll lymphomas of the leg) and in one melanoma reexcision patient of 40 contr ol subjects. The relationship between B. burgdorferi and PCBCL was signific ant when compared with the control groups separately (p <0.05) or in combin ation (p <0.01). These results provide strong evidence to support the conce pt of B. burgdorferi-driven lymphomagenesis in the skin.