Bone involvement in primary cutaneous diffuse large B-cell lymphoma, leg-type

We present a case series showing that bone involvement seems to be associated with poor prognosis in primary cutaneous diffuse large B-cell lymphoma, leg-type. Bone localization is not diagnosed with the initial recommended method of thoracic-abdominal-pelvic computed tomography when asymptomatic and affecting the limbs only. If this condition is suspected, patients should be investigated systematically with further imaging, including positron emission tomography, both at baseline and if there is any concern during follow-up. Primary cutaneous diffuse large B-cell lymphoma, leg-type (PCDLBCL-LT) is an aggressive cutaneous lymphoma. Bone involvement is rare and poorly described. We present five cases of PCDLBCL-LT with bone localization. In four cases, the bone involvement was diagnosed during the initial staging with positron emission tomography (PET) or computed tomography (CT) scan, and in the fifth case after tibial fracture during treatment with rituximab (RTX) and polychemotherapy (PCT). PCDLBCL-LT can be asymptomatic and involve bone sites distant from cutaneous lesions. None had other extracutaneous involvement. In our series, all patients received RTX-PCT as first-line chemotherapy and all had early relapses or progression. Second-line treatments had poor efficacy. Our series shows that bone involvement seems to be associated with poor prognosis in PCDLBCL-LT. Bone localization is not diagnosed with initial thoracic-abdominal-pelvic CT when asymptomatic and affecting the limbs only. If there is a suspicion of PCDLBCL-LT, patients should undergo systematic investigation with alternative imaging techniques, including PET, both at baseline and if there is any concern during follow-up.

Automated summary

We present a case series showing that bone involvement seems to be associated with poor prognosis in primary cutaneous diffuse large B-cell lymphoma, leg-type. Bone localization is not diagnosed with the initial recommended method of thoracic-abdominal-pelvic computed tomography when asymptomatic and affecting the limbs only. If this condition is suspected, patients should be investigated systematically with further imaging, including positron emission tomography, both at baseline and if there is any concern during follow-up.