Research article - Volume 4 - Issue 2
Systemic anaplastic T-cell lymphoma and extrafacial basal cell carcinoma: A unique combination
Sqalli Houssini Ghita*; Elloudi Sara; Douhi Zakia; Soughi Meryem; Baybay Hanane; Mernissi Fatima Zahra
Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Received Date : Feb 02, 2024
Accepted Date : Feb 29, 2024
Published Date: Mar 07, 2024
Copyright: © Ghita SH 2024
*Corresponding Author : Ghita SH Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Email: gsqallihoussini@gmail.com.
DOI: Doi.org/10.55920/2771-019X/1643
Introduction
Non-Hodgkin's lymphomas (NHL) constitute heterogeneous group of lymphopathies. There appears to be an increased risk of secondary cancers, particularly non-melanocytic skin tumors with a more aggressive behavior, in patients with non-hodgkin’s lymphoma [1]. We report the case of a patient hospitalized for the management of systemic lymphoma in whom a pigmented basal cell carcinoma (BCC) of the breast was discovered.
Observation
A 77-year-old female patient, who has a medical history of treated and declared cured lymph node tuberculosis, and tuberculous mastitis currently under radiological surveillance and currently in remission. Admitted for the management of a cervical tumor evolving for the past month in a context of general deterioration. The examination revealed an ulcerated and budding tumor of 7cm on the right lateral neck(fig1). A pigmented plaque on the right breast, oval-shaped, of 2 cm, has been present since a young age according to the patient(fig2), with dermoscopy showing digitiform pigmented structures and a cogwheel appearance suggestive of pigmented superficial basal cell carcinoma(fig.3). Given this presentation, scrofuloderma tuberculosis, T CD30 cutaneous lymphoma, and mammary lymphoma with cutaneous extension were considered. The
Figure 1: Bulky ulcerated and budding tumor on the right lateral cervical region.
Figure 2: Pigmented plaque on the right breast with a chronic course.
histology and immunohistochemistry of the tumor showed an ulcerated cutaneous T-cell lymphoproliferation with large cells CD30+, and the staging revealed secondary involvement of the lungs, liver, spleen, subphrenic region, as well as the discovery of a paraneoplastic pulmonary embolism. The evolution was fatal, and the patient died before the start of chemotherapy.
Discussion
BCC is considered among skin tumors with low metastatic potential, most frequent in men. In immunocompromised individuals, especially those with NHL, BCC is more common, with a recurrence rate of up to 22% at 5 years [2]. Various hypotheses about this association have been proposed,
Figure 3: Dermoscopic examination of the pigmented plaque on the right breast shows digitiform structures at the periphery and a cogwheel appearance suggestive of a pigmented superficial basal cell carcinoma.
including immunosuppression caused by lymphoma. In these patients, deficient expression of CD40 ligand on T lymphocytes hinders their interaction with B lymphocytes and antigenpresenting cells. Additionally, altered expression of major histocompatibility complex and granulocyte function has been noted, contributing to the accumulation of mutagenic events [1,3]. The idea that UV radiation could be associated with the development of lymphoma and skin cancer is interesting, but there are no consistent data, and some reports are contradictory [2]. Our case illustrates a unique situation where a primary cutaneous lymphoma was initially suspected, but systemic investigation corrected the diagnosis. The discovery of a BCC evolving for years in a sun-protected area preceding the diagnosis of such an aggressive lymphoma is challenging to explain: could it be the immunosuppressive effect of UV that favored the development of both malignancies, even though our patient's BCC was located in a sun-protected area? Or is it the immunosuppression of lymphoma that favored the development of the non-melanocytic tumor, even though our patient's BCC preceded the onset of lymphoma? The theory of a common genetic component could explain the association of both entities, but there are only a few case reports regarding the occurrence of melanoma and lymphoma.
Conclusion
Non-melanocytic skin tumors such as BCC are frequently associated with systemic lymphomas. They are more recurrent and aggressive when they occur after lymphoma. Their presence earlier suggests the hypothesis of a common pathophysiological mechanism between the two tumors, as was the case with our patient.
References
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- Brewer JD, Habermann TM, Shanafelt TD. Lymphoma-associated skin cancer: incidence, natural history, and clinical management. Int J Dermatol. 2014; 53(3): 267-74.
- Brewer JD, Shanafelt TD, Khezri F, Sosa Seda IM, Zubair AS, Baum CL et al : Increased incidence and recurrence rates of nonmelanoma skin cancer in patients with non-Hodgkin lymphoma: a Rochester Epidemiology Project population-based study in Minnesota. J Am Acad Dermatol. 2015; 72(2): 302-9.
