Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8557-8562
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8557
Disseminated soft tissue diffuse large B-cell lymphoma involving multiple abdominal wall muscles: A case report
Chang-Hoon Lee, So-Yeon Jeon, Ho-Young Yhim, Jae-Yong Kwak
Chang-Hoon Lee, So-Yeon Jeon, Ho-Young Yhim, Jae-Yong Kwak, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Author contributions: Lee CH wrote the manuscript; Jeon SY collected and validated data; Yhim HY revised manuscript; Kwak JY was in charge of patient treatment and designed the paper; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jae-Yong Kwak, MD, PhD, Professor, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, South Korea. jykwak@jbnu.ac.kr
Received: May 25, 2021
Peer-review started: May 25, 2021
First decision: June 15, 2021
Revised: June 23, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: October 6, 2021
Processing time: 126 Days and 5.2 Hours
Abstract
BACKGROUND

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and patients with DLBCL typically present rapidly growing masses. Lymphoma involving muscle is rare and accounts for only 5%; furthermore, multiple muscles and soft tissue involvement of DLBCL is unusual. Due to unusual clinical manifestation, accurate diagnosis could be delayed.

CASE SUMMARY

A 61-year-old man complained of swelling, pain and erythematous changes in the lower abdomen. Initially, soft tissue infection was suspected, however, skin lesion did not respond to antibiotics. 18Fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography demonstrated FDG uptake not only in the skin and subcutaneous tissue of the abdomen but also in the abdominal wall muscles, peritoneum, perineum, penis and testis. DLBCL was confirmed by biopsy of the abdominal wall muscle and subcutaneous tissue. After intensive treatment including chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone, central nervous system prophylaxis (intrathecal injection of methotrexate, cytarabine and hydrocortisone) and orchiectomy, he underwent peripheral blood stem cell mobilization for an autologous hematopoietic stem cell transplantation. Despite intensive treatment, the disease progressed rapidly and the patient showed poor outcome (overall survival, 9 mo; disease free survival, 3 mo).

CONCLUSION

The first clinical manifestation of soft tissue DLBCL involving multiple muscles was similar to the infection of the soft tissue.

Keywords: Primary extranodal diffuse large B-cell lymphoma; Soft tissue lymphoma; Disseminated muscles and soft tissue invasion; Atypical presentation of diffuse large B-cell lymphoma; Central nervous system relapse; Case report

Core tip: The majority of diffuse large B-cell lymphomas (DLBCLs) initially present in lymph nodes as rapidly growing masses. Herein, we report an unusual case of DLBCL involving multiple muscles and soft tissue and appearing as soft tissue inflammation. Soft tissue biopsy was performed because there was no response to antibiotics, and DLBCL was confirmed. Despite aggressive chemotherapy and central nervous system (CNS) prophylaxis, the disease recurred with CNS invasion and progressed rapidly. This case highlights that skin invasions of aggressive lymphoma should be considered if there is a soft tissue infection that is unresponsive to antibiotics or progresses rapidly.