Yusuf İslam EREN
Acta Haematologica Oncologica Turcica - 2026;59(1):66-69
Primary cutaneous diffuse large B-cell lymphoma, leg-type (PCDLBCL-LT), is an uncommon and aggressive form of non-Hodgkin lymphoma with a poor prognosis. We report the case of an 89-year-old woman who presented with a rapidly enlarging cutaneous nodule on her right thigh. The lesion, which appeared 1.5 months earlier, measured 2x2 cm and displayed homogeneous pink, structureless areas with hemorrhagic foci on dermatoscopy. The patient's history included Alzheimer's disease, epilepsy, a congenital solitary kidney, cerebrovascular disease resulting in a bedridden state, and a prior basal cell carcinoma. An excisional biopsy with a 0.5 cm margin was performed for diagnostic and therapeutic purposes. Histopathological analysis revealed diffuse infiltration by large atypical lymphocytes with hyperchromatic nuclei and frequent mitotic figures. Immunohistochemistry showed positivity for cutaneous diffuse-20 (CD20) and B-cell lymphoma-2 (BCL-2), while CD3, CD10, BCL-6, and cellular myelocytomatosis were negative. The Ki-67 proliferation index was notably high (90-95%), confirming the aggressive nature of the lymphoma. Based on these findings, a diagnosis of PCDLBCL-LT was established. Given the patient's advanced age, comorbidities, and the family's preference to avoid systemic therapy, no additional treatments such as chemotherapy or radiotherapy were pursued. The patient remained recurrence-free over a one-year follow-up period. This case underscores the importance of early recognition of atypical skin lesions in elderly patients and highlights that surgical excision alone may be an effective, minimally invasive treatment option in selected frail individuals. Early intervention not only aids in local disease control but may also help maintain quality of life without the risks associated with aggressive therapies.
