Non-Hodgkin's lymphoma involving chronic difficult-to-heal wounds: A case report

Abstract

BACKGROUND

Non-Hodgkin's lymphoma (NHL) is a malignant tumor that originates from the lymphoid tissues and can potentially affect numerous organs within the body. Among these, the skin stands out as one of the primary sites affected by NHL, often presenting with multiple extra-nodal manifestations. In this report, we present an unusual case of NHL involving chronic wounds in the lower extremities that were difficult to heal. The scars were successfully treated using radiotherapy in combination with extended excision debridement and peroneal artery perforator flap grafting, resulting in satisfactory outcomes.

CASE SUMMARY

A 19-year-old male patient presented with ulceration of the skin on the left calf near the ankle accompanied by purulent discharge. Subsequent pathologic biopsy confirmed a diagnosis of NHL (extranodal NK/T-cell lymphoma, nasal type). Initial treatment comprised local radiotherapy and wound care; however, the wound exhibited prolonged non-healing. Consequently, the patient underwent a series of interventions including radiotherapy, wound enlargement excision debridement, and peroneal artery perforator flap grafting. Ultimately, successful healing was achieved with favorable postoperative outcomes characterized by good texture of the flap without any signs of rupture or infection.

CONCLUSION

The combination of radiotherapy, wound enlargement excision debridement, and peroneal artery perforator flap grafting may present a favorable treatment modality for chronic non-healing lower leg wounds resulting from NHL.

Keywords: Non-Hodgkin's lymphoma; Extranodal natural killer/T-cell lymphoma; Difficult-to-heal wounds; Flap therapy; Case report

Core Tip: Non-Hodgkin's lymphoma represents the majority of lymphoma cases, and extranodal natural killer/T-cell lymphoma, a rare subtype, is characterized by its rarity, high aggressiveness, and poor prognosis. Skin lesions typically present as nodules and hard lumps, with wounds in the lower limbs being relatively uncommon. Here we present the case of a 19-year-old male diagnosed with non-Hodgkin's lymphoma due to an 11-month history of chronic skin breakdown with effusion on the left lower leg near the ankle. Conventional radiotherapy and wound care resulted in poor wound healing. However, after undergoing radiotherapy followed by wound enlargement excision debridement combined with peroneal artery perforator flap grafting, the wound healed successfully.