Radiotherapy in aggressive cutaneous pseudolymphoma: a case report and review of literature

Abstract

Pseudolymphoma is a nonspecific disease characterized by lesions with lymphomatous-appearing but benign accumulation of inflammatory cells. They generally present as small ulcero-nodular lesions confined to skin which often respond to local therapies. We describe an unusual presentation of an extensive and locally aggressive cutaneous pseudolymphoma in a 21-year-old male patient who presented with extensive cutaneous eruptions gradually progressing over 6 years to involve the entire circumference of his left arm. Magnetic resonance imaging scans of his left arm showed a lesion deeply infiltrating into the soft tissue reaching up to the humerus with intense periosteal reaction. He was successfully treated with radiotherapy after many failed attempts with surgery and chemotherapy.

Keywords: Pseudolymphoma; Radiotherapy.

Fig. 1. (A) Pre-treatment photograph showing involvement of the entire circumference of the arm with extensive ulcero-nodular skin lesions with diffuse scaling, bleeding and crust formation. (B) Post-treatment photograph showing complete resolution of the skin lesions.

Fig. 2. (A) Coronal (T1-weighted) and (B) axial (T2-weighted) magnetic resonance images showing locally invasive cutaneous and subcutaneous lesion along the middle and lower third of left upper arm reaching up to the shaft of the humerus with dense periosteal thickening.

Fig. 3. (A) Section shows skin with focal ulceration and acanthosis. Dermis shows diffuse inflammatory infiltrate (H&E, 100×). (B) Section shows dense infiltrate composed of lymphocytes, histiocytes, eosinophils, mast cells and neutrophils, along with foreign-body type giant cells (H&E, 100×).