10.5826/dpc.1204a169
text/xml
2160-9381
2094
en
Mauro Alaibac
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Wolf's response
Primary cutaneous follicle center B lymphoma at the site of a resolved herpes zoster eruption
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2021-11-11
2022-10-31
2022-11-30
e2022169
Dermatol Pract Concept
Mauro Alaibac
2022/10/31
10.5826/dpc.1204a169
e2022169
University of Padova, Department of Medicine, Dermatology Unit
2160-9381
Wolf's response
en
e2022169
Primary cutaneous follicle center B lymphoma at the site of a resolved herpes zoster eruption
https://dpcj.org/index.php/dpc/article/download/2094/1777
Primary Cutaneous Follicle Center B-cell Lymphoma
 at the Site of a Resolved Herpes Zoster Eruption
                    Francesco Messina1, Giulia Tadiotto Cicogna1, Roberto Salmaso1,
                                Riccardo Rondinone1, Mauro Alaibac1


1 Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy



Key words: herpes zoster, lymphoma, clobetasol, Wolf response
Citation: Messina F, Tadiotto Cicogna G, Salmaso R, Rondinone R, Alaibac M. Primary cutaneous follicle center B lymphoma at the site of
a resolved herpes zoster eruption. Dermatol Pract Concept. 2022;12(4):e2022169. DOI: https://doi.org/10.5826/dpc.1204a169
Accepted: March 3, 2022; Published: October 2022
Copyright: ©2022 Messina et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial 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: Francesco Messina, MD, Dermatology Unit, Department of Medicine, University of Padua, Via Vincenzo Gallucci 4,
35128 Padua, Italy. Email: francescomexina@gmail.com




Introduction                                                             scapular region, whose distribution was perfectly overlap-
                                                                         ping with the resolved shingles eruption (Figure 1A).
In this report we describe the occurrence of a primary cutane-                A biopsy was performed, and the histologic specimen
ous follicle center B lymphoma in a skin area which had been             showed a proliferation of neoplastic follicle center cells
previously affected by a herpes zoster eruption. The rarity              ­invading the entire dermis (Figure 2). Epidermis was spared
of this phenomenon and its complete remission with topical               and separated from the proliferating lymphocytes by a grenz
steroid monotherapy make this report quite remarkable.                   zone in the upper dermis. B-cell immunohistochemistry was
                                                                         positive for CD20 and Bcl6 and only weakly positive for
                                                                         Bcl2. Furthermore, PCR demonstrated monoclonal immuno-
Case Presentation
                                                                         globulin heavy chain gene rearrangement. Thus, a diagnosis
We present the case of a 73-year-old man who came for the                of cutaneous follicle center lymphoma was made.
first time to our Dermatology Unit in 2019 for a burning and                  The patient had no medical history of malignancy, and
stinging blistering eruption on the left scapular area with a            his only comorbidity was hypertension. A PET-TC was per-
metameric distribution, highly indicative for a herpes zoster            formed to complete the staging and it resulted negative. This
outbreak. We treated him with acyclovir 800 mg five times                outcome justified a conservative approach, therefore we pre-
daily for seven days with a complete resolution of lesions.              scribed clobetasol propionate topical ointment 0.05% one
    After seven months the patient returned complaining                  application per day to treat the skin lesions. After 6 weeks,
about the development of six infiltrated plaques on the left             all lesions were already in complete remission (Figure 1B).




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022169                                                                          1
Figure 1. (A) Clinical appearance of lymphomatous plaques on the patient left scapular region. (B) Complete resolution of lesions after
topical steroid application.


                                                                              In order to explain this phenomenon, it has been
                                                                           ­suggested that varicella-zoster virus (VZV) infection might
                                                                           cause an abnormal lymphocytic activation; however, only
                                                                           in isolated cases VZV DNA was found in the histologic
                                                                           specimen [1,2]. An additional explanation might be that
                                                                           VZV infection locally reduces the immune surveillance,
                                                                           thereby facilitating the onset of neoplasms in the affected
                                                                           area [1].
                                                                              In this report we have described the appearance of a
                                                                           primary cutaneous follicular B-cell lymphoma in the same
                                                                           area where a shingles outbreak had occurred 7 months
                                                                           before. One similar case already described in literature
                                                                           ­
                                                                           regarded a centrocytic/centroblastic lymphoma which

Figure 2. Bioptic specimen of one of the lesions. A neoplastic infiltra-
                                                                           was treated with systemic interferon alpha obtaining only
tion of atypical lymphocytes is observed in the dermis (H&E x20).          partial remission [2]. In contrast, our case went into sta-
                                                                           ble remission after application of topical steroids alone
                                                                           and to date no recurrence was observed after 14 months
                                                                           of ­
                                                                              follow-up, suggesting that clobetasol monotherapy
Conclusions
                                                                           might represent a valid treatment option for this kind of
The occurrence of a skin disease in an area which had                      ­cutaneous neoplasm.
previously been affected by another unrelated dermatosis is
known as Wolf isotopic response. This phenomenon often
                                                                           References
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                                                                               2012;103(9):798–805. DOI: 10.1016/j.ad.2012.02.007. PMID:
tologic malignancies, skin tumors, and infections have
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                                                                            2. Drago F, Rampini P, Lugani C, Rebora A. Centroblastic-
pseudo-lymphomatous infiltrates have been observed in the                      centrocytic lymphoma arising at the site of previous herpes
area of a former herpes zoster [1], while the onset of primary                 zoster eruption. Acta Derm Venereol. 1998;78(1):74–75. DOI:
cutaneous lymphomas in this setting is only anecdotal [2].                     10.1080/00015559850135959. PMID: 9498039.




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