10.5826/dpc.1202a64
text/xml
2160-9381
1801
en
Banu Farabi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
serpetine vessels
Cutaneous Involvement of Mantle Cell Lymphoma: Report of Two Cases with Dermatoscopic Features
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-05-23
2022-05-02
2022-05-24
e2022064
Dermatol Pract Concept
Banu Farabi
2022/05/02
10.5826/dpc.1202a64
e2022064
Department of Internal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA
2160-9381
serpetine vessels
en
e2022064
-Swoboda R, Kaminska-Winciorek G, Jaworska M, Giebel S. Dermoscopic follow-up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp. J Cosmet Dermatol. 2018 Dec 5. DOI: 10.1111/jocd.12826. Epub ahead of print. PMID: 30520227.
Cutaneous Involvement of Mantle Cell Lymphoma: Report of Two Cases with Dermatoscopic Features
https://dpcj.org/index.php/dpc/article/download/1801/1564
 Cutaneous Involvement of Mantle Cell Lymphoma:
 Report of Two Cases with Dermatoscopic Features
   Bengü Nisa Akay1, Banu Farabi2, Mehmet Fatih Atak1, Isinsu Kuzu3, Aylin Okcu Heper3


1 Department of Dermatology, Ankara University, Ankara, Turkey
2 Department of Internal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA
3 Department of Pathology, Ankara University, Ankara, Turkey



Key words: mantle cell lymphoma, dermatoscopy, dermoscopy, prognosis, serpentine vessels
Citation: Akay BN, Farabi B, Atak MF, Kuzu I, Heper AO. Cutaneous Involvement of Mantle Cell Lymphoma: Report of Two Cases with
Dermatoscopic Features. Dermatol Pract Concept. 2022;12(2):e2022064. DOI: https://doi.org/10.5826/dpc.1202a64
Accepted: September 6, 2021; Published: April 2022
Copyright: ©2022 Akay 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: Banu Farabi, MD, PGY-1, Department of Medicine, Saint Peter’s University Hospital-Rutgers Robert Wood Johnson
Medical School, 4th Floor CARES, 240 Easton Avenue, New Brunswick, NJ 08901. E-mail: banufarabi91@gmail.com




Introduction                                                             in August 2018 (Figure 1A). Dermatoscopic examination
                                                                         showed pink white structureless lesions with unfocused
Mantle cell lymphoma (MCL) is a rare aggressive B-cell lym-              thick serpentine vessels (Figure 1B). Second patient was a
phoma and represents 6% of all non-Hodgkin lymphomas.                    66-year-old female diagnosed with MCL in 2017, admit-
Cutaneous involvement (CI) of systemic MCL is rarely re-                 ted for multiple nodular lesions developed on the trunk
ported and is related to poor prognosis. Skin involvement                and extremities in January 2019 (Figure 1C). Dermato-
in systemic lymphomas (SLs) can be challenging. Dermatos-                scopic examination showed thick serpentine-branched and
copy may serve as a useful tool to diagnose and ameliorate               reticular vessels on whitish-pink violaceous background
the prognosis by leading early diagnosis. In this context, we            (Figure 1D). Both lesions were biopsied and showed sim-
present two cases of MCL with secondary CI, who presented                ilar features including diffuse infiltration of the mid and
with widespread plaques and nodules and describe their der-              deeper dermis with medium-sized lymphocytes with irreg-
matoscopic features.                                                     ular nuclei. The tumor cells were positive for CD5, CD20,
                                                                         CD79a, cyclin D1, and negative for CD10 (Figure 2). Both
                                                                         patients were diagnosed with CI of MCL. They have been
Case Presentations
                                                                         treated with combined chemotherapy regimens including
The first patient was a 73-year-old male diagnosed with                  rituximab, unfortunately both patients were deceased due
MCL in 2014. He referred to dermatology department for                   to disease dissemination (14 months and 18 months after
asymptomatic pink-red colored generalized skin lesions                   CI, respectively).




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022064                                                                       1
    Figure 1. (A,B) Clinical and dermatoscopic pictures of case 1. (A) Multiple erythematous indurated papules and plaques on the fore-
    head. (B) The dermatoscopic image shows pink and white structureless lesions with unfocused thick short serpentine vessels. (C,D)
    Clinical and dermatoscopic photos of case 2. (C) Multiple, purple-colored nodular lesions on the right anterior leg. (D) the dermato-
    scopic image shows thick vessels, branched, and reticular vessels on purple, pink and white background.




Discussion                                                              short linear vessels with multiple red dots within hair follicles
                                                                        on a whitish background. As the lesion progressed, wider telan-
MCL originates from primarily lymph nodes and extra-nodal               giectatic vessels on a reddish background were observed, and
organs (bone marrow, spleen, gastrointestinal tract). Skin in-          the lesions regressed under treatment [2]. We observed pink and
volvement portends a poor prognosis and is seen in 2% of                white structureless lesions with unfocused thick short serpen-
the cases. Previously, 24 cases of secondary CI of MCL have             tine vessels in flat lesions, as lesions became nodular as in our
been reported.                                                          second patient, the vessel calibers increased, branched and re-
     The value of dermatoscopic examination in cutaneous lym-           ticular vessels were observed on purple-pink, white background
phomas (CL) have been proposed in previously published stud-            which is hypothetically due to increased tumor volume and ex-
ies. A recent systematic review regarding dermatoscopic findings        pansion of the dermis by malignant infiltrate.
in primary CLs showed that dermatoscopy assisted skin biop-
sies ensure early diagnosis based on the findings such as salm-
on-colored background, fine short/linear irregular serpentine
                                                                        Conclusions
vessels, scale, and white areas/circles [1]. Regarding the derma-       Skin involvement in MCL suggests poor prognosis. Though,
toscopic features of secondary CI of SLs, only 1 case of MCL            dermatoscopic features are not specific to CI of SLs, they can
has been reported and showed multiple chaotically distributed           raise suspicion to biopsy these lesions in earliest stages.



2                                                                            Research Letter | Dermatol Pract Concept. 2022;12(2):e2022064
Figure 2. Histological and immunohistochemical findings of the papules from case 2. (A) Diffuse proliferation of small atypical lymphoid
cells with fine chromatin (H&Ex10). The subcutaneous atypical lymphoid cells were expressing strong CD20 (b) and CD5 (c) , pale IgD(d).
(E,F) The cells were specifically negative for CD3 (e) and positive for cyclin D (f).


References                                                             2. Swoboda R, Kaminska-Winciorek G, Jaworska M, Giebel S.
                                                                          Dermoscopic follow-up of therapeutic response in mantle cell
 1. Sławińska M, Sokołowska-Wojdyło M, Olszewska B, Nowicki               lymphoma with secondary involvement of the scalp. J Cosmet
    RJ, Sobjanek M, Zalaudek I. Dermoscopic and trichoscopic              Dermatol. 2018 Dec 5. DOI: 10.1111/jocd.12826. Epub ahead
    features of primary cutaneous lymphomas - systematic review.          of print. PMID: 30520227.
    J Eur Acad Dermatol Venereol. 2021;35(7):1470-1484. DOI:
    10.1111/jdv.17219. PMID: 33710688.




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022064                                                                         3
