Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma that classically presents with rapidly enlarging lymph nodes. We present a 59-year-old man with unusual clinical presentation of numb chin syndrome (NCS) as the first symptom of disease. On evaluation, he was found to have diffuse extranodal skeletal involvement in the form of lytic-sclerotic lesions and minimal lymphadenopathy. Bone marrow biopsy revealed a poorly differentiated tumour with infarction and extensive myelofibrosis. This was subsequently proven to be DLBCL of germinal centre type on immunohistochemical stain. NCS should alarm the clinician to investigate for an advanced underlying malignancy. Extensive myelofibrosis, though described in carcinomas and low grade lymphomas, may also be seen in high grade DLBCL.
- malignant and benign haematology
- cranial nerves
Statistics from Altmetric.com
Contributors AJ: senior resident who has seen the patient in outpatient department and was involved in writing the manuscript. SR: senior resident who was involved in making diagnosis of diffuse large B-cell lymphoma in pathology and writing of manuscript. MUSS was involved in making diagnosis of diffuse large B-cell lymphoma and correction of manuscript. PM was the treating physician of this patient and corrected the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.