B Cell Lymphoma Flashcards
B Cell Lymphoma
Cancer of the lymphocytes, B cell lymphomas account for the majority of non hodgkins lymphomas. Skin is the primary site.
Epidemiology
adults, a/w borrelia or h.pylori infections but pathogenesis is unknown. Higher in those with HIV d/t immunodeficiency
Indolent CBCL
Primary cutaneous follicle center lymphoma, primary cutaneous marginal zone b cell lymphoma
Intermediate clinical behavior
primary cutaneous diffuse large cell b cell lymphoma, intravascular diffuse large b cell lymphoma
Primary cutaneous follicle center lymphoma – clinical features
pink or plum solitary or grouped papules, plaques or tumors. do not ulcerate. location: scalp, forehead, back. Asymptomatic lesions lactate dehydrogenase (LDH) WNL. Good prognosis. Dermatopathology; centrocytes and centroblasts present.
Primary cutaneous marginal zone b-cell lymphoma – clinical features
pink/violet/dark red brown papules, nodules, plaques. rarely ulcer. asymptomatic. Location: upper extremities, possibly legs. LDH WNL. Excellent prognosis. Dermatopathology: patchy cells, abundant cytoplasm, “Dutcher bodies” important dx clue.
Primary cutaneous diffuse large b cell lymphoma, leg type – clinical features
solitary or clustered, red/brown, may have adjacent erythematous papules, distal portion of one or both legs, commonly ulcerate, older females. 5 year survival rate: 50%. dermatopath: immunoblasts, dense infiltrates, centroblasts.
Intravascular diffuse large b-cell lymphoma
indurated violet erythematous patches or plaques. location: trunk and thighs. prognosis is fair if confined in the dermis, poor if systemic. dermatopath: large, atypical lymphocytes in the vasculature of the dermis.
Treatment of CBCL low grade lesions
watch and wait, follow every 6 months or sooner for new lesions. IL steroids, localized radiation, IL interferon a2a injections, excision then localized radiation
tx if a/w borrelia or h. pylori
appropriate abx
tx of disseminated diffuse disease, high grade lesions, and intravascular diffuse large b cell
oncology ref. need “CHOP” cyclophospharmide, doxorubicin, vincristine, prednisone f/u with rituximab
Most patients with low grade cutaneous b cell lymphoma need no treatment other than
“watchful waiting”
definitive dx of CBCL
repeat exams of the patient and repeat bx to correctly classify the pt
work up
CBCL may be a secondary site, needs complete staging. Blood work, flow cytometry of peripheral blood, CT chest, CT abdomen, CT pelvis, bone marrow bx with flow cytometry of the aspirate
