A case report of extranodal diffuse large B-cell lymphoma involving upper limb soft tissue in a patient with rheumatoid arthritis on immunosuppressive therapy

Submitted: 25 June 2023
Accepted: 13 February 2024
Published: 25 March 2024
Abstract Views: 1241
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An 80-year-old woman affected by rheumatoid arthritis on immunosuppressive therapy was evaluated for an 11-month history of swelling of her left upper limb. The patient did not report systemic symptoms. Ultrasonographic examination showed hypoechoic masses in the upper limb soft tissue, brachial vein thrombosis, and suspected malignant axillary lymphadenopathy. The patient underwent an excisional biopsy of the lymphadenopathy for histologic examination; a diagnosis of diffuse large B-cell lymphoma was made. The patient started anticoagulation therapy and chemotherapy, with a follow-up at a hematology clinic. At a 3-month follow-up visit in our clinic, the swelling of her left upper limb decreased, and an ultrasonographic control demonstrated a reduction in the size and number of the soft tissue masses and resolution of vein thrombosis.

Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin's lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin's lymphoma classification project. J Clin Oncol 1998;16:2780-95. DOI: https://doi.org/10.1200/JCO.1998.16.8.2780

Fallah M, Liu X, Ji J, et al. Autoimmune diseases associated with non-Hodgkin lymphoma: a nationwide cohort study. Ann Oncol 2014;25:2025-30. DOI: https://doi.org/10.1093/annonc/mdu365

Sapkota S, Shaikh H. Non-Hodgkin lymphoma. Treasure Island, FL: StatPearls; 2023.

Singh R, Shaik S, Negi BS, et al. Non-Hodgkin's lymphoma: a review. J Family Med Prim Care 2020;9:1834-40. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1037_19

Derenzini E, Casadei B, Pellegrini C, et al. Non-Hodgkin lymphomas presenting as soft tissue masses: a single center experience and meta-analysis of the published series. Clin Lymphoma Myeloma Leuk 2013;13:258-65. DOI: https://doi.org/10.1016/j.clml.2012.10.003

Vitolo U, Seymour JF, Martelli M, et al. Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016;27:v91-v102. DOI: https://doi.org/10.1093/annonc/mdw175

Liu Y, Barta SK. Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment. Am J Hematol 2019;94:604-16. DOI: https://doi.org/10.1002/ajh.25460

Siddiqui RS, Ferman D, Tuli S, et al. Diffuse large B-cell lymphoma of the left upper extremity mimicking a sarcoma. Cureus 2021;13:e15588. DOI: https://doi.org/10.7759/cureus.15588

Hung LK, Cheng JC, McGuire LJ, Tsao SY. Primary malignant lymphoma of the deep tissues of the hand. J Hand Surg Am 1988;13:683-6. DOI: https://doi.org/10.1016/S0363-5023(88)80123-0

Toprak H, Kiliç E, Serter A, et al. Ultrasound and Doppler ultrasound in evaluation of superficial soft-tissue lesions. J Clin Imaging Sci 2014;4:12. DOI: https://doi.org/10.4103/2156-7514.127965

Jacobson JA, Middleton WD, Allison SJ, et al. Ultrasonography of superficial soft-tissue masses: society of radiologists in ultrasound consensus conference statement. Radiology 2022;304:18-30. DOI: https://doi.org/10.1148/radiol.211101

Schmidt RA, Lee AYY. How I treat and prevent venous thrombotic complications in patients with lymphoma. Blood 2022;139:1489-500. DOI: https://doi.org/10.1182/blood.2019003689

Niitsu N, Okamoto M, Nakamine H, et al. Clinicopathologic correlations of diffuse large B-cell lymphoma in rheumatoid arthritis patients treated with methotrexate. Cancer Sci 2010;101:1309-13. DOI: https://doi.org/10.1111/j.1349-7006.2010.01517.x

Lang R, Gill MJ. Diffuse large B-cell lymphoma. N Engl J Med 2021;384:2261-2. DOI: https://doi.org/10.1056/NEJMc2105452

Solimando AG, Annese T, Tamma R, et al. New insights into diffuse large B-cell lymphoma pathobiology. Cancers (Basel) 2020;12:1869. DOI: https://doi.org/10.3390/cancers12071869

Ciampi, S. A., & Petrelli, C. (2024). A case report of extranodal diffuse large B-cell lymphoma involving upper limb soft tissue in a patient with rheumatoid arthritis on immunosuppressive therapy. Geriatric Care, 10(1). https://doi.org/10.4081/gc.2024.11541


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