Indian Journal of Pathology and Microbiology
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Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 87
Malignant lymphoma presenting as nonhealing ulcer

Department of Pathology, Government Medical College, Bhavnagar, Gujarat, India

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How to cite this article:
Shah S. Malignant lymphoma presenting as nonhealing ulcer. Indian J Pathol Microbiol 2008;51:87

How to cite this URL:
Shah S. Malignant lymphoma presenting as nonhealing ulcer. Indian J Pathol Microbiol [serial online] 2008 [cited 2023 Nov 30];51:87. Available from:


Involvement of skin in a malignant lymphoma is relatively uncommon. Ulceration in malignant lymphoma is a rare and aggressive presentation. A variety of lymphomas can cause cutaneous ulceration. [1] Ulceration as clinical presentation of lymphoma is an atypical phenomenon. [2] Patients with lymphomas and cutaneous ulcers have poor prognosis. [3] Commonly, the ulcers occur later in the course of lymphomas and frequently the ulcers are multiple, necrotic, infected, and placed on tumors. [3] A case of malignant non-Hodgkin lymphoma presenting as nonhealing ulcer is reported.

A 55-year-old man was admitted to the hospital with chief complain of a nonhealing ulcer on the back. Initially a biopsy was taken and it was diagnosed as a small cell carcinoma. Subsequently excision biopsy was done. The ulcer was 6 x 7 cm 2 in size on upper back with yellowish-black slough and foul smelling discharge. The margin was indurated. Multiple small firm swellings were present in the surrounding area. Right supraclavicular nodes were enlarged. Two tissue bits were received. The bigger was 13 x 15 x 4 cm 3 in size and was partially covered with skin. Cut surface was homogenous white. The smaller bit was 6 x 6 x 3 cm 3 in size. Outer surface was irregular and cut surface was yellowish-white and soft. The sections stained with hematoxylin and eosin (H&E) reveal structure of skin with tumor mass in the dermis and subcutaneous tissue. The mass was composed of diffusely infiltrating neoplastic cells. The cells were uniform small and round to oval in shape with small ovoid hyperchromatic and vesicular nuclei and small nucleoli.

Immunohistochemistry was done. Chromogranin, synaptophysin, cytokeratin, and neuron-specific enolase were negative and leucocyte common antigen was positive. Ultimately, the diagnosis of malignant lymphoma, non-Hodgkin's, diffuse and small cell was given.

There are many ways in which the lymphomas can involve skin. [4] In one study, 133 cases out of 1610 (8.26%) of non-Hodgkin's lymphoma presented with skin involvement. [5] All types of non-Hodgkin's lymphoma show predilection for head and neck region. [5] The skin lesions usually are in the form of nodules, tumors, and plaques. [6] The histologic findings in malignant lymphoma with ulceration ranges from a nonspecific inflammatory infiltrate to ulcers with marked adjacent epidermal epidermotropism to ulcers with an angiocentric infiltrate without epidermotropism. The prognosis of patients with lymphoma and cutaneous ulcers is poor and average life expectancy after ulcer formation is 21 months. [1] Commonly, the ulcers occur later in the course of lymphomas and may be the cause of sepsis. [3] Sepsis was the main cause of mortality in one study of ulcerated cutaneous lymphomas and most cases were secondary to Staphylococcus aureus and Pseudomonas aeruginosa . [3]

A variety of lymphomas may cause cutaneous ulceration so adequate sampling of these ulcers is necessary for the diagnosis.

   References Top

1.Helm KF, Su WP, Muller SA, KurTin PJ. Malignant lymphoma and leukemia with prominent ulceration: clinicopathologic correlation of 33 cases. J Am Acad Dermatol 1992;27:553-9.  Back to cited text no. 1  [PUBMED]  
2.Grau E, Real E, Perella M, Escandon J, Pastor E, Gomer A. Cutaneous B cell lymphoma with aggressive clinical presentation: Apropos of a case. Sangre (Bare) 1997;42:231-3.  Back to cited text no. 2    
3.Carbia SG, Hochman A, Dei-Cas I, Lagodin C, Melgar A, Allevato M, et al . Ulcerated cutaneous lymphoma. 10 years of experience. Medicina (B Aires) 2000;60:565-9.  Back to cited text no. 3    
4.Connors JM, Hsi E-D, Foss FM. Lymphoma of the skin. Hematology (Am Soc Hematol Edu Program) 2002;263-82.  Back to cited text no. 4    
5.Yaqoob N, Noorali S, Nasir MI, Perver S. Non-hodgkin's lymphomas presenting as cutaneous lesions. J Coll Physicians Surg Pak 2003;13:29-32.  Back to cited text no. 5    
6.Wolk BH. Primary malignant lymphoma cutis. Can Med Assoc J 1977;117:750-3.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]

Correspondence Address:
S Shah
Department of Pathology, 11, Kalpdroom flats, Near Takhteshwer post office, Waghawadi road, Bhavnagar, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.40412

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