Relapse of Laryngeal Mucosa-associated Lymphoid Tissue Lymphoma in the Skin

The prognosis for patients with lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is good, but multifocal lesions appear in 30-40% of patients. We report a 65-year-old woman who presented with painless, firm nodules on her right arm and face. Mine years previously, the patient presented at Tzu Chi Hospital with hoarseness and a sensation of a lump in the throat. She was first diagnosed with primary MALT lymphoma of the larynx. Subsequently, multiple painless nodules were noted on her right eyelid, right axilla, and right arm. The intervals between recurrences became shorter and skin lesions relapsed more frequently. The nodules were resected and histopathology showed small B-cells including marginal zone (centrocyte-like) cells, monocytoid cells, and small lymphocytes. Most centrocyte-like cells showed positive staining for CD20 marker in the plasma membrane—this is entirely specific for B-lymphocytes. Follicular dendritic-like cells had positive staining with stromal cell-derived factor-la (SDFla) antibody. The nuclei of the centrocyte-like cells stained positive with CXCR4, a ligand of SDFla. This may indicate that MALT lymphoma grows in a self-sustained microenvironment.