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Intralesional Cisplatin for the Treatment of Cutaneous B-Cell Lymphoma

1998; American Medical Association; Volume: 134; Issue: 11 Linguagem: Inglês

10.1001/archderm.134.11.1343

1538-3652

Werner Kempf, R. Dummer, Monika Hess Schmid, Tanja Fritz, Brunello Wüthrich, Guenter Burg,

Toxin Mechanisms and Immunotoxins

A 56-year-old white woman presented with a solid erythematous nodule on her scalp that had developed 6 years earlier. She denied having a fever, losing weight, or sweating during the night. Her medical history was notable for epilepsy, which was adequately controlled with phenothiazine and chlorpromazine therapy. When a solitary nodule first appeared on the patient’s head 6 years earlier, a biopsy specimen revealed nodular, dense B-cell infiltrates without blasts, nuclear atypias, or mitoses. Therefore, the lesion had been regarded clinically and histologically as a B-cell pseudolymphoma. The patient was subsequently treated with potent topical corticosteroid creams and local psoralen–UV-A, but within 2 years the preexisting nodule became larger and 2 further nodules appeared despite the therapy. After topical chemotherapy using carbomustine and topical corticosteroids, the patient had a partial response consisting of a reduction in tumor size, but the tumors recurred after a few months. The results of a physical examination showed that she had 4 dense, erythematous, smooth nodules with a median size of 3 cm on the frontal and parietal areas of her scalp accompanied by alopecia (Figure 1). No enlarged lymph nodes were palpable. The results of a histopathological examination of the nodules revealed a dense nodular infiltrate extending throughout all dermal layers into the subcutaneous fat, exhibiting a follicular pattern that was separated from the epidermis by an uninvolved grenz zone. Cytomorphologically germinal center–derived cells with pale cytoplasm, pleomorphic nuclei, and a few atypical mitoses were found (Figure 2). The cells stained for B-cell markers including CD20 (Figure 2), CD79a, and proliferation-associated Ki-67 marker. Immunohistochemical staining for k and l light chains of immunoglobulins showed a restricted reactivity of the tumor cells for the immunoglobulin k light chain. Genotyping with amplification of immunoglobulinheavy specific regions using a polymerase chain reaction did not reveal a monoclonal B-cell population. A chest x-ray film, an abdominal ultrasonogram, and a computed tomographic head scan showed no abnormal findings. In addition, examination of peripheral blood and a bone marrow biopsy specimen showed no evidence of an extracutaneous lymphoma. Based on histopathological and clinical findings, the diagnosis of a follicle center cell lymphoma of the head and neck, a subtype of a primary cutaneous B-cell lymphoma, was made.