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Case Report
Soft tissue sarcoma unmasked: An atypical presentation of primary cutaneous B-cell lymphoma
1 Resident, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
2 Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
3 Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine; Medical Director of the Clinical Laboratories, Grady Health System, Atlanta, GA, USA
4 Assistant Professor of Surgery, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
Address correspondence to:
Paridhi Agarwal
Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322,
USA
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Article ID: 100162Z10PA2026
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Agarwal P, Bennett FJ, Lopez CA, Roth CG, Mason MC. Soft tissue sarcoma unmasked: An atypical presentation of primary cutaneous B-cell lymphoma. J Case Rep Images Oncology 2026;12(2):26–32.ABSTRACT
Introduction: Primary cutaneous follicle center lymphoma (PCFCL) is the most common subtype of primary cutaneous B-cell lymphoma and is typically an indolent malignancy with an excellent prognosis. However, atypical presentations may mimic soft tissue sarcoma or high-grade lymphoma, creating significant diagnostic challenges.
Case Report: In this report, we describe a unique case of a young male with a history of systemic lupus erythematosus (SLE) who presented with a slowly enlarging, ulcerated soft-tissue mass of the lower back with associated drainage, pain, fever, and weight prompting treatment with dose-adjusted R-EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) loss. Upon admission, cross-sectional imaging and fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) revealed a large (15 cm) right dorsal soft tissue mass with intense FDG uptake. Core needle biopsy initially demonstrated a high-grade appearing B-cell lymphoma with a concern for high grade lymphoma. Following additional immunostaining and multidisciplinary hematopathology review, the diagnosis was revised to PCFCL with a diffuse growth pattern. The patient completed four cycles of inpatient chemotherapy with a reduction in mass size after each cycle.
Conclusion: Here we present a case of PCFCL with a diffuse growth pattern that mimicked both soft-tissue sarcoma and high-grade B-cell lymphoma, highlighting the importance of prompt tissue diagnosis and comprehensive pathologic evaluation.
Keywords: Diffuse growth pattern, Primary cutaneous B-cell lymphoma, Primary cutaneous follicle center lymphoma, Soft tissue mass, Soft tissue sarcoma
SUPPORTING INFORMATION
Acknowledgments
The authors would like to thank the Department of Surgery, the Department of Hematology and Medical Oncology, and the Department of Pathology and Laboratory Medicine at Emory University School of Medicine for their academic support and resources during the preparation of this manuscript.
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Author ContributionsParidhi Agarwal - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Frances J Bennett - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carlos A Lopez - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Christine G Roth - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Meredith C Mason - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementVerbal informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Paridhi Agarwal et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
