No evidence of Borrelia in cutaneous infiltrates of B‐cell lymphomas with a highly sensitive, semi‐nested real‐time polymerase chain reaction targeting the 5S‐23S intergenic spacer region

Abstract

Background The role of Borrelia in the development of skin lymphomas has been under discussion for decades. A similar association has been shown for Helicobacter pylori and gastric lymphomas (MALT type). Nevertheless, few molecular studies investigated Borrelia in skin lymphomas and the results are controversial. Methods We analysed 46 formalin‐fixed, paraffin‐embedded skin specimens of clincopathologically confirmed B‐cell lymphomas (15 marginal zone lymphomas; 20 follicular lymphomas; three diffuse large B‐cell lymphomas; eight secondary cutaneous infiltrates) taken from 36 patients from Northern Germany, an endemic area for Borrelia. Fifteen pseudolymphomatous lesions of cutaneous Borreliosis served as the control. Both groups were examined with a real‐time (rt) PCR and a semi‐nested PCR targeting the 5S‐23S intergenic spacer region (IGS). A multiplex PCR was used to investigate B‐cell clonality in all lymphomatous infiltrates (Biomed Primers). Results With both assays no Borrelia burgdorferi‐specific DNA was identified in any of the B‐cell lymphomas, while all 15 Borreliosis specimens gave a positive PCR result in the semi‐nested PCR protocol, 12 were also positive in the rt PCR (P < 0.01). All B‐cell lymphomas showed monoclonal IgH‐Rearrangement. Analysis of cutaneous B‐cell lymphomas from available studies including ours (n = 334) reveals an odds ratio <1. Conclusion While some previous studies suggested an association between B. burgdorferi and the development of cutaneous B‐cell lymphomas in endemic areas, we were unable to confirm this in our patients, despite a highly sensitive Borrelia PCR assay. Our results including meta‐analysis of previous studies question the need for antibiotic therapy in patients with cutaneous B‐cell lymphomas.

Linfoma cutáneo primario de células B de la zona marginal recurrente. Presentación de un caso

“…Se cree que inician como procesos linfoproliferativos reactivos en los cuales la estimulación antigénica crónica, como en las infecciones bacterianas y virales, puede ser un factor predisponente 10,11 . En el caso del LCCB-ZM, se han reportado casos asociados con infección por Borrelia burgdorferi, en particular en Europa, pero no se ha demostrado su asociación en otras series 12,13 .…”

Acrodermatitis chronica atrophicans with clonal light chains and heavy chain rearrangement

“…11 The results of Borrelia detection in pcMZL are heterogeneous and might be also influenced by geographic features. 12,13…”