An Unusual Case of Extranodal Diffuse Large B-Cell Lymphoma Infiltrating Skeletal Muscle: A Case Report and Review of the Literature

Abstract

Diffuse large B-cell lymphoma is extranodal in approximately 40% of cases, arising in nearly any organ system. DLBCL involvement of soft tissue and in particular skeletal muscle is extremely rare, comprising less than 1% of all extranodal non-Hodgkin lymphomas (NHL). We report a case of a 79-year-old man that presented with a DLBCL of the left triceps. In particular, we describe an unusual histologic appearance of pseudoglandular structures, resembling adenocarcinoma. We performed a review of lymphoma cases involving skeletal muscle diagnosed at our institution over the past 15 years as well as thorough PubMed review of the literature. We discuss the features of lymphoma involving skeletal muscle as it pertains to clinical characteristics, histologic subtype, tumor localization, diagnostic studies, therapy, and outcome. Finally, we highlight the diagnostic difficulties that can present in these rare and often challenging cases.

ABC‐type diffuse large B‐cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature

“…Several other investigators have also described DLBCL presenting as shoulder pain. Characteristics of these patients are summarized in Table . Patients ranged in age from 30 to 80 years and most commonly presented with shoulder pain, stiffness, or both.…”

“…Characteristics of these patients are summarized in Table 1. [15][16][17][18][19][20][21][22][23] Patients ranged in age from 30 to 80 years and most commonly presented with shoulder pain, stiffness, or both. There was a significant male gender predilection.…”

“…presenting as shoulder pain. [15][16][17][18][19][20][21][22][23] malignancy. A careful physical examination with appropriate follow-up laboratory and imaging studies can help establish an early diagnosis.…”

Isolated skeletal muscle recurrence of an originally nodal diffuse large B cell lymphoma

“…[ 2 , 3 ] The gastrointestinal tract is mostly affected, while extranodal sites of involvement described include the testes, skin, lung, bone, central nervous system, and the respiratory system. [ 2 , 3 ] Primary skeletal muscle presentation of DLBCL is extremely rare, with an estimated incidence of about 0,5% of extranodal lymphomas, [ 3 ] presenting mostly in the lower extremities. [ 2 ] Involvement of the skeletal muscles upon recurrence of an initially nodal DLBCL is rare.…”

“…[ 2 , 3 ] Primary skeletal muscle presentation of DLBCL is extremely rare, with an estimated incidence of about 0,5% of extranodal lymphomas, [ 3 ] presenting mostly in the lower extremities. [ 2 ] Involvement of the skeletal muscles upon recurrence of an initially nodal DLBCL is rare. The possible mechanisms of muscle involvement of DLBCL include primary extranodal disease, extension from adjacent organs (such as lymph nodes) or disseminated disease.…”