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EBV+ cutaneous B‐cell lymphoproliferation of the leg in an elderly patient with mycosis fungoides and methotrexate treatment
Author(s) -
Rausch Thierry,
Cairoli Anne,
Benhattar Jean,
Spring Philipp,
Hohl Daniel,
Leval Laurence
Publication year - 2013
Publication title -
apmis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 88
eISSN - 1600-0463
pISSN - 0903-4641
DOI - 10.1111/j.1600-0463.2012.02939.x
Subject(s) - mycosis fungoides , methotrexate , medicine , mucocutaneous zone , lymphoma , lymphoproliferative disorders , lymphomatoid papulosis , pathology , biopsy , monoclonal , pathological , cutaneous lymphoma , skin biopsy , gene rearrangement , dermatology , immunology , monoclonal antibody , antibody , disease , biology , biochemistry , gene
A 77‐year‐old man with a 5‐year history of mycosis fungoides ( MF ) who had received several lines of therapy, including intravenous courses of Methotrexate ( MTX ) for the past 2 years, went on to develop several ulcerated cutaneous nodules on the left leg. Biopsy revealed diffuse sheets of EBV ‐positive large B cells ( CD 20+ CD 30 ± I g M Lambda), with an angiocentric distribution and a monoclonal IGH gene rearrangement. Although the pathological features were diagnostic for an EBV ‐positive diffuse large B‐cell lymphoma ( DLBCL ), several possibilities could be considered for assignment to a specific entity: EBV ‐positive DLBCL of the elderly, methotrexate‐induced lymphoproliferative disorder ( LPD ), lymphomatoid granulomatosis, or the more recently described EBV ‐positive mucocutaneous ulcer. The development of EBV+ lymphoproliferations has been reported in two other patients with MF under MTX , and occurred as skin lesions of the leg in one of these and in the current case, which may question the relatedness to primary cutaneous DLCBL , leg‐type.