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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