Unusual Clinical Presentation of a Primary Cutaneous Follicle Center Lymphoma on the Scalp of a Middle-Aged Female: Case Report and Review of the Literature

Primary Cutaneous Follicle Center Lymphoma of the Eyelid in a Young Man

A 20-year-old male presented with a fast-growing nodule in his right inferior eyelid, no relevant history was obtained. Final histopathologic diagnosis of primary cutaneous follicle center lymphoma (CD20+, CD10+, bcl6+, bcl10+, mum1+, PAX5+, and bcl2-) was determined. The patient had a complete negative systemic work-up, and 3 cycles of consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy were completed. The initial histopathologic diagnosis had been a non-Hodgkin diffuse large B-cell lymphoma which is an infrequent lymphoma type for this location too. To our knowledge, this is the youngest person reported presenting with an eyelid primary cutaneous follicle center lymphoma.

An unusual case of B-cell lymphoma of the scalp

B-cell lymphoma is a lymphoproliferative non-Hodgkin lymphoma arising from B cells, a type of immune lymphocytes that produces antibodies in the follicles of lymph nodes. Primary cutaneous B-cell lymphoma (PCBCL), a subtype of B cell lymphoma, originates within cutaneous tissue without evidence of extracutaneous involvement. There are very few reports of PCBCLs originating in the scalp. The most common tumors of the scalp are usually benign with only 1%-2% being malignant, most being basal cell carcinoma, squamous cell carcinoma, or melanoma. Primary cutaneous follicular cell lymphoma (PCFCL) is regarded as the most common lymphoma of the skin with an indolent course and favorable prognosis due to the response rate to treatment methods such as surgical removal with local radiotherapy, topical drugs, and intralesional therapies. This report highlights a rare case of PCFCL originating in the scalp, to raise awareness of a topic that requires continued established management.

Aggressive primary scalp lymphoma mimicking an acute epidural hematoma: Case report and Review of the literature

BACKGROUND

Cutaneous Central Follicular Lymphoma (CCFL) is a Type B cutaneous lymphoma with a usually indolent course. Scalp localization of CCFL is extremely rare, we report a new case mimicking an epidural hematoma, and showing a rapid progression with aggressive infiltration of skin, calvaria, dura and brain parenchyma.

CASE REPORT

A 58-year-old patient with an unlabeled polymalformative syndrome was admitted to the Emergency department following a head injury secondary to a self-resolving tonic-clonic epileptic seizure. The initial CT scan was interpreted as a minor subcutaneous and epidural hematoma initially deemed for conservative management. Within 4 days the patient showed a progressive neurological deterioration culminating into a stuporous status which prompted a constrast-enhanced brain MRI. The scan revealed a multilayered solid lesion, extending from the subgaleal compartment to the subdural space, threatening the integrity of overlying skin and causing infiltration of the brain parenchyma. Following emergency neurosurgical excision a definitive histology diagnosis of central follicular lymphoma was made. A focused chemotherapy with high-dose Methotrexate with R-CHOP protocol led to disease control until the latest follow up at 2 years.

CONCLUSION

To our knowledge, this case represents the first CCFL invading the brain parenchyma and the second extending to the dura. Although such tumor is usually indolent the aggressive behavior herein reported extend the differential diagnosis to high-grade meningiomas, sarcomas, and metastases. Prognostication and appropriate adjuvant treatment require prompt surgical excision and histological confirmation.