An extremely rare presentation of non-Hodgkin lymphoma in the head and neck: a case report

Abstract

Background Non-Hodgkin lymphoma (NHL) frequently presents as extra-nodal involvement, although primary diffuse large B cell lymphoma of extra-nodal origin is a distinct entity. Different subtypes may have propensity for specific anatomic locations. In the head and neck region, diffuse large B cell lymphoma (DLBCL) is most commonly presented in the paranasal sinuses, jaws, and Waldeyer’s ring. DLBCL involving fibroadipose tissue and presenting as an extra-nodal mass is extremely unusual, particularly in the head and neck region. Case presentation We will present a case of forehead mass as presenting features of a highly aggressive B cell lymphoma. Conclusion Although soft tissue DLBCL presenting as scalp mass is rare, it should be considered in differential diagnosis of every soft tissue lump.

A Rare Case of Diffuse Large B-Cell Lymphoma Found in the Subcutaneous Scalp

“…The patient's history of multiple benign cysts of various sizes could have made the diagnosis easy to miss, assuming a presumptive diagnosis of a benign cyst. The presentation described today is not often seen [2][3] and is considered a high-grade lymphoma [4][5]. Of all forms of DLBCL, extranodal forms only comprise 34.48% [10].…”

“…Rare sites of extranodal DLBCL have been documented in the literature, including presentations in the scalp, testicles, bone, bladder, and nasal septum [2][3][6][7][8][9]. A recent 2022 study found that the percentages of extranodal DLBCL from years 2000-2015 at the age of 18 or greater in their search were as follows: GI tract 28.31%, nervous system 13.78%, head and neck 11.79%, skin and soft tissue 9.54%, genitourinary 7.24%, musculoskeletal 5.80%, respiratory tract 5.17%, pancreas and hepatobiliary 4.16%, endocrine organs 3.66%, heart and mediastinum 3.28%, breast 2.49%, bone marrow 2.47%, and others 2.30% [10].…”

“…Diffuse large b-cell lymphoma (DLBCL) represents approximately one-third of all non-Hodgkin's lymphomas [1]; extranodal presentation on the scalp is rare [2][3]. Rare extranodal presentations documented in the literature include the scalp, testicles, bone, bladder, and nasal septum, whereas, the gastrointestinal tract is the most common extranodal site [2][3][4][5][6][7][8][9]. Skin involvement in DLBCL can occur as a primary or secondary manifestation, which can be difficult to differentiate [1,4].…”

“…Different subclassifications can have different prognoses and require different treatments [1]. In these rare cases, the primary extranodal masses can present as subcutaneous or cutaneous involvement mimicking a subcutaneous cyst [1][2][3][4]. Primary cutaneous large b-cell lymphoma is a subclass that presents without evidence of internal or disseminated disease [1].…”