Psoriasis vulgaris and B-cell non-Hodgkin lymphoma: a complex case with rare cephalic localization

Abstract

Introduction. Psoriasis is a chronic immune-mediated inflammatory condition and is considered a potential risk factor for the development of hematologic malignancies, particularly in the context of immunosuppressive therapy and T-cell dysfunction. B-cell non-Hodgkin lymphomas are neoplasms of the lymphatic system with variable clinical manifestations, most commonly presenting with peripheral lymphadenopathy. Primary localization in the soft tissues of the head, with bone invasion, is rare. Case presentation. We report a rare case of cephalic aggressive NHL Not Otherwise Specified (NOS) in a 63-year-old patient with a history of psoriasis vulgaris and Clear cell carcinoma (T1N0M0, treated in 2021 at the Oncology Institute in Chișinău), who presented with a painless right temporo-parietal mass. MRI revealed a 48×19×50 mm lesion in the temporal soft tissues with extension into the frontal bone. Surgical biopsy and immunohistochemistry (CD20+, CD79a+, CD45+, BCL6-) confirmed the diagnosis of B-cell NHL NOS. In 2022, the patient received 8 induction cycles of immunochemotherapy followed by maintenance therapy with Rituximab. PET/CT evaluation showed a Deauville score of 3, indicating a partial favorable response. Associated comorbidities (psoriasis, type 2 diabetes mellitus, hypertension) required multidisciplinary monitoring. Conclusions. This case illustrates an unusual cranial localization of aggressive B-cell lymphoma NOS and highlights the potential link between psoriasis and lymphoproliferative risk, as previously suggested in the medical literature.