10.5826/dpc.1203a132
text/xml
2160-9381
2041
en
Joel Schwartz
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
psoriasis
Lymphoma developing in a patient with long-term antitumor necrosis factor therapy
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-09-15
2022-07-28
2022-09-15
e2022132
Dermatol Pract Concept
Joel Schwartz
2022/07/28
10.5826/dpc.1203a132
e2022132
Dermatologist at Private Practice, Porto Alegre- Brazil
2160-9381
psoriasis
en
e2022132
Wong AK, Kerkoutian S, Said J, Rashidi H, Pullarkat ST. Risk of lymphoma in patients receiving antitumor necrosis factor therapy: a meta-analysis of published randomized controlled studies. Clin Rheumatol. 2012;31(4):631-636. DOI: 10.1007/s10067-011-1895-y. PMID: 22147207.2. Fiorentino D, Ho V, Lebwohl MG, et at. Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry. J Am Acad Dermatol. 2017;77(5):845-854. DOI: 10.1016/j.jaad.2017.07.013. PMID: 28893407.
Lymphoma developing in a patient with long-term antitumor necrosis factor therapy
https://dpcj.org/index.php/dpc/article/download/2041/1662
                    Dermatology Practical & Conceptual


          Lymphoma Developing in a Patient With
        Long-term Antitumor Necrosis Factor Therapy
        Giovana Serrão Fensterseifer1, André Carvalho2, Ana Letícia Boff3, Joel Schwartz4


1 Dermatologist at Private Practice, Dermatologist at Dermatology Department at Hospital São Lucas da PUCRS, Porto Alegre- Brazil
2 Dermatologist at Private Practice, Dermatologist at Hospital Moinhos de Vento, Porto Alegre- Brazil
3 Pathologist at Private Practice, Pathologist at Dermatology Department at Santa Casa de Misericórdia de Porto Alegre, Porto Alegre- Brazil
4 Dermatologist at Private Practice, Porto Alegre- Brazil



Key words: lymphoma, antiTNF, adalimumab, psoriasis
Citation: Fensterseifer GS, Carvalho A, Boff AL, Schwartz J. Lymphoma developing in a patient with long-term antitumor necrosis factor
therapy. Dermatol Pract Concept. 2022;12(3):e2022132. DOI: https://doi.org/10.5826/dpc.1203a132
Accepted: December 6, 2021; Published: July 2022
Copyright: ©2022 Fensterseifer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Giovana Serrão Fensterseifer, MD, Rua Professor Langendonck, 117. Porto Alegre- Brazil, +55 51 99240-4660,
E-mail: gfensterseifer@gmail.com




Introduction
Some studies have shown that tumor necrosis factor (TNF)
alfa inhibitor therapy may increase the risk of lymphomas
[1]. It is historically known that psoriasis can also increase
the risk of cutaneous lymphomas. Here we present a case
of a primary cutaneous anaplastic large cell lymphoma in a
patient under treatment with adalimumab for psoriasis and
psoriatic arthritis.


Case Presentation
Patient presented to the clinic with a shallow one-month
ulcerative lesion, with infiltrated borders on the buttock. The
patient had been on adalimumab for, approximately, the last
10 years due to psoriasis and psoriatic arthritis (Figure 1).
A biopsy was performed for histopathology and immuno-
histochemistry analysis. The report showed cohesive sheets
of large CD30-positive anaplastic cells confirming the                          Figure 1. Ulcer on the buttock.



Research Letter | Dermatol Pract Concept. 2022;12(3):e2022132                                                                              1
Figure 2. (A) Histopathology shows (x10) an acanthotic epidermis and a diffuse infiltrate of lymphocytes and some neutrophils on the
dermis. (B) Histopathology shows (x40) a diffuse lymphocyte infiltrate with irregularly shaped nuclei, prominent nucleoli and abundant
cytoplasm. (C) Immunohistochemistry shows CD3 positive lymphocytes. (D) Immunohistochemistry shows diffuse and strong positivity for
CD30 on neoplastic cells.


diagnosis of CD30+ anaplastic T-cell lymphoma. Staging               for malignancy [2]. The patient presented here had been un-
determined a cutaneous primary lymphoma with no other                der treatment for, approximately, 10 years.
organs involved. The patient is currently under treatment for           In conclusion, studies are controversial regarding if there
the disease (Figure 2).                                              is an increased risk of malignancy due to anti-TNF alfa
                                                                     therapy, with a tendency of relating it to the duration of
                                                                     the treatment. We presented a case of a patient with a long-
Conclusions
                                                                     term treatment with adalimumab for psoriasis and psoriatic
Studies have shown that the most common lymphoma                     arthritis who developed a cutaneous lymphoma. Further
subtype associated with anti-TNF therapy is non-Hodgkin              studies are needed to determine the risk of lymphomas in
B-cell lymphoma [1]. In the other hand, it is known that pso-        patients with long term anti-TNF therapy, but physicians
riasis itself can increase the risk of cutaneous lymphoma. In        should remain aware of this possibility when following
this case, T-cell lymphoma is the most associated lymphoma           patients under this treatment.
subtype, mainly mycosis fungoides. Our patient presented
a primary cutaneous anaplastic large cell lymphoma. This
                                                                     References
subtype of cutaneous T-cell lymphoma usually presents as a
solitary nodule that often develops ulceration, as presented          1. Wong AK, Kerkoutian S, Said J, Rashidi H, Pullarkat ST. Risk
                                                                         of lymphoma in patients receiving antitumor necrosis factor
in this case. The prognosis is usually favorable with extracu-
                                                                         therapy: a meta-analysis of published randomized controlled
taneous dissemination occurring in approximately 10% of
                                                                         studies. Clin Rheumatol. 2012;31(4):631-636. DOI: 10.1007/
the patients. Radiotherapy is usually the initial choice of              s10067-011-1895-y. PMID: 22147207.2. Fiorentino D, Ho V,
treatment, but chemotherapy could also be considered. More               Lebwohl MG, et at. Risk of malignancy with systemic psoria-
recently, a study by Langley et al stated that longer-term               sis treatment in the Psoriasis Longitudinal Assessment Registry.
(≥ 12 months) treatment with a TNF alfa inhibitor, but not               J Am Acad Dermatol. 2017;77(5):845-854. DOI: 10.1016/j.
                                                                         jaad.2017.07.013. PMID: 28893407.
shorter-term treatment, was associated with increased risk




2                                                                        Research Letter | Dermatol Pract Concept. 2022;12(3):e2022132
