PMC2879550_01
Multiple erythematous to purple, sharply demarcated pruritic nodules in the back that enlarged and coalesced in the last year originating a tumor measuring 11 x 7 cm in diameter with some satellite lesions.
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We describe a case report of a 44-year-old white man with a gastric diffuse large B-cell lymphoma (DLBCL) referred to our clinic by the hematology department because of multiple erythematous to purple, sharply demarcated pruritic nodules in the back that enlarged and coalesced in the previous year originating a tumor measuring 11 x 7 cm in diameter (Figure 1).
Endoscopy revealed two gastric ulcers. Biopsy revealed a DLBCL.
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Pylori positive) (Figure 2) and a computer tomography showed both mural thickening of the gastric mucosa and mediastinal and axilar lymphadenopathy.
Stomach biopsy: (a) H&EX40 (Olympus BX40):DLBCL, (b) antibody staining CD 20+, (c) antibody staining BCL6+, (d) antibody staining Ki67+.
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A gastric biopsy revealed a DLBCL (Figures 3(a)-3(d)).
Skin biopsy 2009: H&EX40 (Olympus BX40) :DLBCL.
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The cells were CD20+, CD3-, CD30-, and BCL6+ and had a high proliferation rate (Ki67+), features compatible with DLBCL (Figure 4).
Skin biopsy 2006: (a) H&EX40 (Olympus BX40):Primary cutaneous follicle center lymphoma, (b) antibody staining CD 20+, (c) antibody staining BCL6+, (d) antibody staining Ki67+.
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On re-examination, the skin biopsy obtained 3 years earlier was BCL2 weakly positive, CD10 negative, CD20 positive, and BCL6 positive and was reclassified as PCFCL (Figure 5).
IgH clonality profiles from the PCFCL skin biopsy (2006) and the DLBCL gastric biopsy (2009). GeneScan results obtained using the BIOMED2: (a) FR1 and FR3 and (b) FR2 VH-JH tubes (peaks in blue: patient and control DNA, peaks in red: TAMRA molecular weight marker). The same 328 base pair and 258 base pair monoclonal product is detected in both the skin and gastric biopsies, after FR1 (a) and FR2 (b) PCR amplification, respectively. No PCR product was detected after FR3 amplification (a) probably due to somatic hypermutation.
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In each biopsy an identical clonal VH-JH rearrangement was detected using FR1 and FR2 primers: 328 base pairs (bps) and 258 bps, respectively (Figures 6(a)-6(b)). 