Acta Dermato-Venereologica 99-1CompleteContent | Page 36

121 Rapidly Growing Tumour on the Forearm of an 83-year-old Woman: A Quiz Chakib EL HABNOUNI 1,2 , Hélène CORNILLIER 1,2 , Valérie TAUVERON 2 , Serge GUYETANT 1,3 and Annabel MARUANI 1,2 1 University of Tours, 2 Department of Dermatology, CHRU Tours, FR-37044 Tours Cedex 9, and 3 Department of Pathology, CHRU Tours, Tours, France. E-mail: [email protected] An 83-year-old woman underwent a radical mastectomy with axillary lymph-node dissection on the left side to treat breast cancer, followed by chemotherapy and radiation therapy in 2006. Three years after the radiation therapy, chronic lymphoedema developed in her left arm. In March 2018, the patient reported erythema and indura- tion with a small erythematous nodule on her left forearm. Topical steroids had no clinical benefit. Two months later, the first nodular lesion rapidly increased in size, to reach 15 cm in circumferential length (Fig. 1a). Multiple violaceous satellite lesions developed within the area of the erythema and induration and extended to the chest wall (Fig. 1b). Blood cell count and results of haemostasis, liver and renal function tests were within normal limits. Doppler ultrasound examination of the left forearm revealed arterial blood flow inside the main lesion. Two nodular lesions on the chest were biopsied. Histopath­ology with immunochemistry showed extensive infiltration of the dermis by atypical cells positive for CD31 and negative on pan-cytokeratin and human herpesvirus-8 staining. What is your diagnosis? See next page for answer. Fig. 1. (a) Clinical photography of the left forearm of an 83-year-old woman with a violaceous skin tumour and surrounding satellite lesions. (b) Clinical image: extensive lesions on the chest wall (ecchymotic areas with lilaceous nodules). (c) Coloration haematoxylin phloxine saffron stain (HPS), ×10 magnification: section of a cutaneous papule from the chest revealing a normal epithelium and a dermis infiltrated by irregular anastomosing vascular channels. (d) Immunochemistry, ×10 magnification: infiltration of dermis by CD31 + cells. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3054 Acta Derm Venereol 2019; 99: 121–122