Large B-cell lymphoma of the leg

A 74-year-old Mexican man presented with an 18-month history of multiple, v iolaceous, coalescing, firm, tender nodules with an ulcer in the anterior a spect of the right leg (Fig. 1) and slightly infiltrated, ill-defined eryth ematous plaques affecting the left leg and both forearms, He had not receiv ed any treatment for his condition. Past medical history was relevant for n oninsulin-dependent diabetes mellitus and hypertension without formal treat ment and a history of heavy alcohol intake in his youth. A biopsy specimen of both plaque-type lesions of the forearm and tumorous lesions of the leg showed a diffuse, nonepidermotropic mononuclear infiltrate throughout the d ermis and extending to the subcutis. The infiltrate was composed of pleomor phic, atypical, large mononuclear cells (Fig. 2). Immunostaining with CD20 was positive for the atypical cells while CD3 was positive for normal appea ring lymphocytes, characterized as reactive T cells. Additional laboratory and image studies ruled out extracutaneous involvement. The diagnosis of pr imary cutaneous large B cell lymphoma of the leg (LBCLL) was made. The pati ent was initiated on radiotherapy localized to the right leg with a very go od initial response nevertheless, resolution was not achieved and the plaqu es in the rest of the limbs remained unchanged. Thus, the patient started c hemotherapy with CHOP (Cyclophosphamide, Vincristine, Doxorubicin, Predniso ne). He has currently finished his fourth cycle with this chemotherapy regi men. The tumorous lesions involuted leaving only residual hyperpigmentation (Fig. 3) and the plaques in the rest of the limbs disappeared, the area of the ulcer diminished considerably. There is still no evidence of extracuta neous involvement.