27426 A young man with an impressive ulcer on the chest
Sagher E, and Axelson A. 27426 A young man with an impressive ulcer on the chest. J Am Acad Dermatol 2021; 85(3):AB143.
J Am Acad Dermatol
Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), and when cutaneous, may be limited to the skin or internal with metastasis to the skin. Morphologies of cutaneous metastases may be variable, and lymphomas most commonly present with pink-violet to red-brown papulonodules. Although less common, it is important to consider malignancy in the differential when evaluating an ulcer. Here we present the case of a 23-year-old morbidly obese Hispanic male who was hospitalized for inability to ambulate and was found to have nodal diffuse large B cell lymphoma, with full body imaging concerning for metastatic spread. Dermatology was consulted for a 3-month history of an ulcer on his chest, which was originally treated by the surgery team with debridement and antibiotics without improvement. On examination, he had a 8 × 7 × 5 cm ulcer over his left breast with a surrounding violaceous indurated plaque. Punch biopsy showed sheets of large atypical cells in the dermis with immunohistochemistry mirroring that of the lymph node biopsy (positive CD20 and BCL6, negative CD10, and MUM-1). As such, the ulcer was diagnosed as a cutaneous metastasis of nodal DLBCL, and he was started on chemotherapy with rituximab, doxorubicin, vincristine, and prednisone (R-CHOP) followed by radiation to the chest wound.