case_images: PMC11714132_01
case_images: Cutaneous diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements lesion on the lower portion of the leg at initial presentation at the emergency department.
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case_images: A 65-year-old Hispanic man with a past medical history of chronic obstructive pulmonary disease, coronary artery disease, hypertension, 48 pack-year smoking history, and chronic hyponatremia due to possible syndrome of inappropriate antidiuretic hormone secretion, presented to the emergency department for worsening "bug bites," edema, and paresthesia in the lower extremities (Fig 1).
case_images: Cutaneous diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements presentation at outpatient dermatology clinic, a month after initial emergency department presentation.
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case_images: One month after the initial presentation, the patient presented at the outpatient dermatology clinic with 19 tender, skin-colored to red/violaceous plaques and nodules, ranging from 1 to 19 cm in size, located on the trunk and all 4 extremities (Fig 2).
case_images: A, Low-power view histopathology of skin biopsy revealing dermal infiltrate of atypical lymphoid cells, consistent with cutaneous diffuse large B-cell lymphoma/high-grade B-cell lymphoma (DLBCL/HGBCL). B, High power view of cutaneous DLBCL/HGBCL histopathology. C, Cutaneous DLBCL/HGBCL histopathology with immunohistochemistry stain positive for Ki-67, indicating high proliferation.
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case_images: Three biopsies revealed dermal infiltrate of atypical lymphoid cells, which was consistent with DLBCL/high-grade B-cell lymphoma (Fig 3, A, B). Ki-67 stain (90%) revealed a high proliferation rate (Fig 3, C).
case_images: Almost complete resolution of cutaneous lesions of diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements 1 month after initiating chemotherapy.
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case_images: At 1 month into treatment, we observed an almost complete response of his cutaneous lesions (Fig 4), with sparse postinflammatory hyperpigmentation.