b cell lymphoma prognosis | Role of Ki67 in the prognosis of cutaneous centrofolliculaires B lymphomas?

Role of Ki67 in the prognosis of cutaneous centrofolliculaires B lymphomas?



Abstract
Introduction Centrofolliculaire (LBCF) B lymphoma is a non-aggressive and good prognosis lymphoma. We report the case of a 45-year-old patient who had a large LBCF cell Bcl2 − with a high Ki67 (greater than 90%). Despite the factors of good prognosis, the disease evolved into systemic lymphoma with bone impairment. Observations a patient of 45 years of age, type 1 diabetic, consulted in May 2014 for a scalp lesion 2 centimetres in diameter evolving for 6 months. Initially, the lesion was papuleous and not itchy. It gradually increased in volume and became burgeoning, consisting of several nodules performing périfolliculaire hyperplasia with hair coming out of the hair growth apertures. The biopsy carried out was the diagnosis of malignant lymphoma B with large cells of centrofolliculaire origin (CD10 + CD20 + BCL6 +) initially cutaneous [Bcl2 −, without rearrangement t (14; 18)]. The Ki67 was greater than 90%. Blood count and blood immunophenotyping were normal. The toe-scanner of July 2014 showed only a hyperfixing of the lesion of the vertex. The Thoraco-abdominal-pelvic scanner was normal. The patient had been treated by radiotherapy alone at the rate of 30 Gy in 15 sessions. The answer was complete. In March 2015, the onset of lombosacrées pains had motivated the development of an MRI of the lumbar spine and the Sacro-iliac, revealing bone lesions. The pet-scanner confirmed multiple bone and visceral lesions. The removal of the axillary ganglion was carried out with large cell diffuse B lymphoma, developed on a primitive cutaneous LBCF with identical markings [CD10 + CD20 +, Bcl6 +, Bcl2 −, and still no t rearrangement (14; 18)]. Discussion the LBCF Bcl2 −, is a good prognosis lymphoma with a 5-year survival of more than 95%. Ki67 is usually not considered in the prognosis factors of this type of lymphoma. Here it was more than 90%. A study of malignant non-Hodgkin's lymphomas showed a 1-year survival of 18% for patients with a Ki67 greater than 80%, compared with 82% for those with a Ki67 of less than 80%. No studies have yet been carried out on the role of Ki67 in cutaneous LBCF. LBCF may evolve into systemic lymphoma in rare cases, but they are always Bcl2 + with a T rearrangement (14; 18). We have not found in the literature of LBCF primitively cutaneous Bcl2 −, with secondary systemic impairment. Conclusion we report the case of a LBCF Bcl2 −, primitively cutaneous, with systemic evolution. Histological markers were good prognosis except for the high Ki67. The latter could be a significant prognostic factor for this type of lymphoma and encourage more sustained surveillance. It could direct us to a possible systemic evolution of this type of lymphoma usually indolent.