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• W2323290406 abstract "To the Editor: In their letter to the Editor (1), Ferrara and coworkers describe a further case of cutaneous spindle cell B-cell lymphoma occurring on the back of a middle-aged man. They suggest that, although this peculiar type of cutaneous B-cell lymphoma (CBCL) might be interpreted morphologically as a variant of follicle center cell lymphoma (FCCL), the aggressive course observed in their own patient as well as in some of the patients reported in the literature argues against this interpretation, and these cases should therefore be classified as cutaneous B-cell lymphomas with intermediate biologic behavior (1). Recently, another case of CBCL with predominant spindle-cell morphology has been reported by Dr. Goodlad (2). His patient was a 73-year-old woman with a tumor on the scalp. As Ferrara et al. correctly pointed out, most patients observed so far had lesions on the head and neck or on the back, locations that are typical for cutaneous FCCL. The clinical features, especially for lesions arising on the back, are those of so-called reticulohistiocytoma of the back or Crosti's lymphoma, confirming that most of these cases probably belong to this peculiar group of cutaneous B-cell neoplasms. Since publishing our five original cases (3), I have observed a number of specimens of CBCL that presented, at least focally, medium–large spindle cells and/or cells with the bizarre morphology described both in our original article and in the manuscript by Ferrara and coworkers. Indeed, I think today that the great majority of cases of cutaneous spindle cell B-cell lymphoma represents a morphologic variant of cutaneous FCCL, as Dr. Goodlad proposed in his article (2). In my opinion, the large spindle cells with bizarre nuclear shapes correspond mainly to large centrocytes, and probably to a lesser extent to centroblasts. In fact, it is well known that centrocytes and centroblasts may present unusual nuclear morphologic features, such as multilobulation or signet-ring appearance. I have noted these peculiar spindle and bizarre cells in the context of otherwise typical cases of cutaneous FCCL, although, of course, they only rarely constitute the majority of the cells, but are rather scattered throughout the infiltrate (Fig. 1). Interestingly, I recently observed an 84-year-old woman with a previous diagnosis of cutaneous FCCL of the back 93 months before. She had been treated successfully with radiotherapy, and presented after more than 7 years of complete clinical remission with recurrent papules and nodules of a few months duration located at the upper margins of the irradiated area. Histologic examination of the recurrent lesions revealed a CBCL with a prominent population of spindle and bizarre cells. Review of histopathologic sections from the original biopsies showed a “common” cutaneous FCCL, indicating that spindle cell B-cell lymphoma in this patient was just a morphologic variant of the previous FCCL. In this context, I should underline that I have observed also otherwise typical cases of large B-cell lymphoma of the leg showing focally small areas with spindle-cell morphology. Nevertheless, in contrast to the spindle cells of FCCL, spindle cells in large B-cell lymphoma of the leg are more monomorphous, larger, and lack the bizarre shapes (boomerang-like, spermatozoa-like) commonly observed in cases of FCCL (Fig. 2).FIG. 1.: Cutaneous follicle center cell lymphoma with scattered spindle cells and cells with bizarre nuclear morphology (arrows).FIG. 2.: Cutaneous large B-cell lymphoma of the leg. A) note fascicle of neoplastic spindle cells within the infiltrate of large round B-lymphocytes (arrow). B) detail showing monomorphous morphology of large spindle cells.Should we consider spindle cell B-cell lymphoma as a lymphoma of intermediate prognosis, as Ferrara and coworkers suggested? I don't know, but I think that, based on a handful of primary cutaneous cases, no final conclusions can be drawn. Patient 1 from our original publication (3) was alive and well at last follow-up control, 64 months after the first diagnosis. Based on the fact that these peculiar cells can be observed in many cases of otherwise typical FCCL, I believe that spindle cell B-cell lymphoma most likely belongs to the same prognostic group of FCCL of the skin. However, as Ferrara and coworkers pointed out, we should keep an open mind, and collect larger numbers of cases of this rare morphologic variant of CBCL to elucidate clinicopathologic and prognostic features of lesions with predominance of spindle cells. Lorenzo Cerroni, M.D." @default.
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• W2323290406 date "2002-12-01" @default.
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• W2323290406 title "Reply to Cutaneous Spindle B-cell Lymphoma: A Reappraisal" @default.
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