Cutaneous presentation of follicular lymphomas

The description of primary cutaneous follicular lymphoma. has raised intere st in the differential diagnosis of this versus disseminated follicular lym phoma involving the skin. We report here on four cases of Stage IV follicul ar lymphoma, diagnosed in skin biopsy, in which cutaneous lesion was the mo st noticeable feature of clinical presentation In all cases, the morphologi cal features were superimposed over typical nodal follicular lymphoma. Apar t from classic B-cell markers, they were characterized by CD10 and bcl6 pos itivity, markers of follicle germinal center cells, and bcl2 expression, wi th a corresponding t(14;18) translocation in three of three cases examined. In all four cases, bone marrow study and clinical staging revealed disease that had disseminated since diagnosis. Follow-up showed relapsing cutaneou s and nodal disease in two cases. The only difference observed with a contr ol group of 10 cases of primary cutaneous follicular lymphoma was the absen ce in this group of t(14; 18). Disseminated classical follicular lymphoma. has to be considered in the differential diagnosis of follicular lymphoma p resenting in the skin. This series of cases suggests that the presence of t (14;18) could imply the existence of disease that has disseminated beyond t he skin and that cases harboring this translocation could be candidates for systemic polychemotherapy.