To the Editor.
—Grem et al1 describe three patients with diffuse enlargement of skeletal muscle of the thigh as a result of infiltration by diffuse large-cell lymphoma. Clinically prominent infiltration of skeletal muscle by lymphoma is very unusual (1% of reported cases of lymphoma). We have seen two similar cases.
Report of a Case.—Case 1.
—A 70-year-old man presented with massive swelling of the left thigh seven months after completing treatment for a diffuse large-cell lymphoma of the axilla and supraclavicular space. He had initially been treated with combination chemotherapy including adriamycin, cyclophosphamide, vincristine sulfate, and prednisone, obtaining a complete clinical response. Muscle biopsy from the thigh demonstrated diffuse large-cell lymphoma. He was treated with lomustine, vinblastine sulfate, and bleomycin sulfate with limited response. Central nervous system and progressive thigh disease subsequently developed that required both intrathecal chemotherapy and systemic etoposide. There was no clinical response and
Spector JI, Zimbler H. Skeletal Muscle Involvement by Lymphoma. Arch Intern Med. 1986;146(6):1232. doi:10.1001/archinte.1986.00360180252051