Cutaneous B cell lymphoma

Question 1

Types of cutaneous B cell lymphoma

Answer 1

Primary cutaneous follicle centre
Primary cutaneous marginal zone
Primary cutaneous diffuse large B cell leg type
Primary cutaneous diffuse large B cell other
Diffuse large B cell lymphoma

Question 2

Primary cutaneous follicular centre lymphoma - prognosis

Answer 2

95% 5 years

Question 3

Primary cutaneous follicular centre lymphoma - clinical features

Answer 3

Solitary or grouped papules, plaques or nodules esp scalp, forehead, neck and trunk

Question 4

Primary cutaneous follicular centre lymphoma- median age of Dx

Answer 4

60

Question 5

Primary cutaneous follicular centre lymphoma - immunohistochemistry

Answer 5

CD20+, CD79a+, Bcl6+ in clusters outside lymph follicles, Bcl2neg

Question 6

Investigations Primary cutaneous follicular centre lymphoma

Answer 6

Bx x2, H&E, immunohistochemistry, FBC, eflts, borrelia

Question 7

Primary cutaneous follicular centre lymphoma - treatment

Answer 7

Radiation 30Gy with margin of 1-1.5cm, surgery, IL IFNalpha, IL Rituximab

Question 8

Primary cutaneous marginal zone lymphoma - clinical features

Answer 8

Solitary or multiple papules, plaques or nodules - trunk or upper extremity. Resolution may be accompanied by secondary anetoderma due to lack of elastic fibres in the area of the tumour.

Question 9

Primary cutaneous marginal zone lymphoma - immunohistochemistry

Answer 9

CD20+, CD79a+, BCL2+, BCl6 neg

Question 10

Primary cutaneous marginal zone lymphoma - 5 year survival - Tx

Answer 10

99%

Question 11

Primary cutaneous marginal zone lymphoma

Answer 11

Local radiotherapy, excision, abs if borrelia. IV Rituximab

Question 12

Prognosis: cutaneous diffuse large B cell lymphoma leg type

Answer 12

5 year survival 50%

Question 13

Immunohistochemistry Primary cutaneous diffuse large B cell lymphoma leg type

Answer 13

Bcl2, MUM1, FOXP1, CD20, CD79a

Question 14

Primary cutaneous diffuse large B cell lymphoma leg type - clinical features

Answer 14

Elderly patients F>M
Usually leg
Solitary or multiple plaques and tumours. Red-blue nodules. Can be annular

Question 15

Treatment Primary cutaneous diffuse large B cell lymphoma leg type

Answer 15

RCHOP with local radiotherapy.

Question 16

Ix of B cell lymphoma

Answer 16

Bx + immunohistochemistry 
FBC, film 
IgH rearrangement if possible 
elfts, LDH, Borrelia serology. 
Refer haematology

Question 17

T/F Bcl is +ve in primary cutaneous follicle centre lymphoma

Answer 17

F - negative (is +ve in systemic )

Question 18

T1 B cell lymphoma T1a or T1b

Answer 18

T1a 5cm

Question 19

T2 B cell lymphoma

T2a,b,c

Answer 19

Multiple lesions limited to 1 area or 2 continuous areas. 15-30cm, c: >30cm

Question 20

T3

Answer 20

Generalised

Question 21

Lennert’s lymphoma

Answer 21

variant of Hodgkin: Lymphadenopathy, fever, wt loss , skin as secondary event

Question 22

Hodgkins immunohistochemistry

Answer 22

CD30+, CD15+

Question 23

Cutaneous features of hodgkins

Answer 23

Pigmentation (usually intertriginous), pruritic - tends to start of legs. Prurigo. Ichthyosiform atrophy. Alopecia, exfoliative dermatitis, herpes zoster, EN