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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
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ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Large B cell diffuse lymphoma, leg type
Introduction

Large B cell lymphomas comprise about 1 – 3% of all cutaneous lymphomas and about 5 – 10% of cutaneous B cell lymphomas. The most common large cell B lymphoma of the skin.

Clinical signs
  • elderly female patients
  • solitary or multiple red to violaceous dense nodules, predominantly on the legs
  • bad prognosis (5 year survival rate is about 50%)
  • recurrences after therapy are common

Large B cell lymphoma (2611)

Pictures

Large B cells lymphoma of the lower legs (65 years old woman): Large cell B cell lymphoma, Clinical picture (2612) Large cell B cell lymphoma, Clinical picture (2611)

Histology

Diffuse growth pattern with infiltrate involving the whole dermis and extending into subcutaneous fat. Remnants of large follicle-like structures.

Neoplastic cells resemble either centroblasts with large non-cleaved nuclei and nucleoli attached to the nuclear membrane, or immunoblasts with large vesicular nucleus and centrally placed prominent nucleolus. In addition multilobated, anaplastic or large cleaved cells may be present. Centrocytes are not present.

Mitotic activity is usually high.

In some cases epidermotropism of the infiltrate may lead to confusion with T cell lymphoma.

Immunophenotype and genetic features:

  • tumor cells: CD20 and CD79a are positive (but loss of B markers may occur)
  • CD10, CD5, CD138 and cyclin D1 are negative
  • Ig light chains expressed on the cell surface or intracytoplasmatically
  • bcl-2 and MUM 1 are positive (important for differentiation from diffuse FCL)
  • bcl-6 is usually positive
  • chromosomal translocation (t8;14) occurs in secondary skin infiltrations in nodal lymphoma cases, but is not present in primary LBCL of the skin

Large B cells lymphoma (2700)

Large B cells lymphoma, CD79a (2702)

Pictures

Large B cells lymphoma of the lower legs (65 years old woman), clinical and histological pictures: Large cell B cell lymphoma, HE 40x (2703) Large cell B cell lymphoma, HE 40x (2704) Large cell B cell lymphoma, HE 100x (2700) Large cell B cell lymphoma, CD3 40x (2701) Large cell B cell lymphoma, CD79a 40x (2702)

Large B cells lymphoma of the lower legs: Large cell B cell lymphoma (LBCL, ALCL), HE 20x (4524) Large cell B cell lymphoma (LBCL, ALCL), HE 20x (4525) Large cell B cell lymphoma (LBCL, ALCL), CD3 20x (4526) Large cell B cell lymphoma (LBCL, ALCL), CD79a 20x (4527)

Large B cells lymphoma, leg type: Large cell B cell lymphoma (LBCL, ALCL), HE 20x (4531) Large cell B cell lymphoma (LBCL, ALCL), CD79a 20x (4530) Large cell B cell lymphoma (LBCL, ALCL), CD20 20x (4529) Large cell B cell lymphoma (LBCL, ALCL), bcl2 20x (4528)