Subcutaneous appearance of a centrocytic Non-Hodgkin lymphoma at the site of injection of a mistletoe preparation

History and clinical findings: A 73-year-old man, first diagnosed as having centrocytic Non-Hodgkin lymphoma 5 years previously, presented with subcutaneous nodes of the abdominal wall at precisely the sites of previous regular injections of a mistletoe preparation. These nodes had first appeared 5 weeks after the first injection. Injections were stopped and he reported to the out-patient clinic. Except for the visible and easily nodes in the anterior wall no other subcutaneous nodes were palpated. Prominent cervical lymphomas and swelling of the epicranial aponeurosis and lower lip had, according to the patient, been present for some time. Investigations: There was a T-lymphocytopenia, lactate dehydrogenase activity was raised to 255 U/l. The subcutaneous nodes in the anterior abdominal wall were also demonstrated by ultrasound. Computed tomography showed them as having the density of connective tissue and being up to 5 cm in diameter. The excised nodes histologically revealed to be infiltrations by the centrocytic lymphoma. Treatment and course: Once the mistletoe injections had been discontinued no further subcutaneous infiltrates were seen despite the progression of the lymphoma. Six weeks later the patient died of bilateral pneumonia. Conclusion: There are pointers that high concentrations of mistletoe preparations subcutaneously injected can have a growth-promoting action on cells of a centrocytic lymphoma. As part of a leukaemic >>wash-out<<, these cells reach the subcutaneous tissue. This proliferative stimulus may have been mediated by a high local concentration of interleukin-6 liberated from the skin by mistletoe lectins.