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Atypical Lymphoid Infiltrate

HISTORY

49-year-old woman presents with a shiny pink papule of the left ear helix. Histology found atypical lymphoid infiltrate suspicious for a cutaneous B cell lymphoma. The area was treated with Mohs excision and closure.

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Left ear helix atypical lymphoid post Mohs.

 

DISCUSSION

Primary cutaneous lymphoma is a low-grade and most-common B-cell lymphoma of the skin. These are primary tumors of the skin that develop slowly. It is also called a primary cutaneous follicle center lymphoma (CFCL). Treatment of solitary tumors includes excision. Mohs excision has no proven advantages over simple excision. Multiple lesions may also present in CFCL form.

Cutaneous follicle center lymphoma is one of three types of cutaneous B-cell lymphomas. Primary cutaneous marginal zone B-cell lymphoma (CMZL) is also a low-grade lesion similar to the mucosa-associated  lymphoid tissue (MALT).

Primary cutaneous diffuse large B-cell lymphoma is more aggressive than the other two types. It represents two types – a leg type (LBCL-L) and a very rare disease that is likely an extension of systemic lymphomas (LBCL-other).

Other treatment options include steroid creams, topical chemotherapy (Mustargen, Valchlor), imiquimod, retinoids, phototherapy (PUVA, BB-UVB, NB-UVB), and radiation therapy.

Cutaneous lymphomas as well-summarized on the Cutaneous Lymphoma Foundation website – www.clfoundation.org.

The other cutaneous lymphomas are T-cell lymphomas and present as either cutaneous form (mycosis fungoides) or systempic leukemic form (Sézary Syndrome).

 

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Atypical lymphoid infiltrate suspicious for a cutaneous B cell lymphoma.