ABSTRACT
The increased use of monoclonal antibodies that target the immune checkpoint T cell receptor programmed death-1 (PD1) to treat numerous solid tumors has led to several reports describing associated cutaneous adverse events. Although lichenoid reactions have been well described, we propose that PD1 inhibitor-induced inverse lichenoid eruption (PILE) is a distinct variant. We describe two patients who presented with nearly identical deeply erythematous, malodorous, eroded anogenital plaques with focal crusting. Diagnosis of PILE was established given the biopsy findings and temporal association with PD1 inhibitor therapy. Treatment with clobetasol ointment was successful without necessitating discontinuation of immunotherapy. The findings were consistent with the only other previously published case of inverse lichenoid eruption in the groin secondary to PD1 inhibitors.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Lichenoid Eruptions/pathology , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Abdomen/pathology , Adenocarcinoma/drug therapy , Aged , Aged, 80 and over , Buttocks/pathology , Clobetasol/administration & dosage , Female , Glucocorticoids/administration & dosage , Humans , Lichenoid Eruptions/drug therapy , Lichenoid Eruptions/etiology , Lung Neoplasms/drug therapy , Middle Aged , Ointments , Perineum/pathology , Skin/pathologyABSTRACT
B-cell lymphoblastic lymphoma (B-LBL) is a malignant neoplasm of immature B cells that accounts for only 10% of all cases of lymphoblastic lymphoma. Most commonly, B-LBL presents as bony lesions, but in rare cases, the disease manifests cutaneously. We present a case of simultaneous cutaneous and systemic presentation of B-LBL in an otherwise healthy 28-year-old man in which the lymphoblastic infiltrate stained positive for CD79a, Tdt, CD10, and CD20. A diagnosis of cutaneous B-LBL was made, and systemic work-up revealed widespread involvement of the skin, bone, and lymph nodes. Review of all currently described cases of cutaneous B-LBL with or without systemic involvement revealed that the most frequently positive tumor markers were CD79a (92.3%), Tdt (90.6%), and CD10 (83.3%). Systemic involvement of B-LBL was found in nearly half of all cases with cutaneous presentation.
Subject(s)
Leukemia, Lymphoid/diagnosis , Lymphoma, B-Cell/diagnosis , Skin Neoplasms/diagnosis , Adult , Antigens, CD20/analysis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/analysis , Biopsy , CD79 Antigens/analysis , DNA Nucleotidylexotransferase/antagonists & inhibitors , Dose Fractionation, Radiation , Hematopoietic Stem Cell Transplantation , Humans , Immunohistochemistry , Leukemia, Lymphoid/immunology , Leukemia, Lymphoid/pathology , Leukemia, Lymphoid/therapy , Lymphoma, B-Cell/immunology , Lymphoma, B-Cell/pathology , Lymphoma, B-Cell/therapy , Male , Neprilysin/analysis , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Skin Neoplasms/therapy , Treatment OutcomeABSTRACT
An otherwise healthy man in his 50s presented complaining of pruritic lesions on the left side of his scalp. The lesions had slowly been growing in size over the preceding 30 years. They would occasionally bleed, and this is what ultimately prompted him to seek medical advice. Physical examination revealed multiple aggregated and soft, flesh-colored nodules on the left posterior auricular area of the scalp (Figure 1). No appreciable clinical lymphadenopathy was identified on examination. A shave biopsy of one of the nodules was performed for diagnostic clarification.