Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 40

SHORT COMMUNICATION
Dystrophic Calcification in a Patient with Primary Localized Cutaneous Nodular Amyloidosis: An
Uncommon Ultrasound Finding
Sergi PLANAS-CIUDAD, Esther ROÉ CRESPO, Juan Francisco MIR-BONAFÉ, Fania Zamantta MUÑOZ-GARZA and Luis PUIG
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, ES-08026, Barcelona, Spain. E-mail: splanas@
santpau.cat
Accepted Sep 13, 2017; Epub ahead of print Sep 13, 2017
Primary localized cutaneous nodular amyloidosis
(PLCNA) is a rare form of primary localized cutaneous
amyloidosis characterized clinically by solitary or mul-
tiple nodules. Although the prognosis is usually good,
an extensive work-up must be performed in all patients
with PLCNA, since it is both clinically and histopatho-
logically indistinguishable from systemic amyloidosis
in up to 40% of cases.
Recently, high-frequency ultrasound (HFUS) has
emerged as a non-invasive imaging method in dermato-
logy. It has been shown to be of significant value for the
study of certain skin tumours or inflammatory conditions.
To our knowledge there are no published reports of ul-
trasound findings in PLCNA.
We report here a case of PLCNA with dystrophic cal-
cification with ultrasound findings. Dystrophic calcifica-
tion is rarely found in PLCNA, but has been reported in
cases of localized amyloidosis of other organs. Thus, we
suggest that PLCNA should be included in the differen-
tial diagnosis of subcutaneous nodules with dystrophic
calcification.
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CASE REPORT
An 84-year-old woman with a medical history of primary
biliary cirrhosis, autoimmune hepatitis and Sjögren’s
syndrome was referred to the dermatology department
for evaluation of 2 painful lesions of 1 year’s duration
on the right leg. Physical examination revealed a 3.5-cm,
well-defined, yellowish, firm, nodule on the medial side
of her right ankle (Fig. 1a) and a 2.5-cm, ill-defined,
yellow patch with focal brown areas on the right knee.
No other clinical features were observed.
High-frequency 22-MHz skin ultrasound of the nodu-
lar lesion revealed an ill-defined heteroechoic mass in the
dermis and subcutaneous tissue and hyperechoic lineal
foci with distal acoustic shadowing suggesting calcifica-
tion (Fig. 1d). A skin biopsy from the nodule showed a
diffuse infiltration of the entire dermis and subcutaneous
tissue by an eosinophilic amorphous material (Fig. 1b). A
perivascular infiltrate of plasma cells with Russell bodies
and the presence of focal dystrophic calcification were
also observed. The eosinophilic amorphous material
Fig. 1. Clinical, histopathologic and
ultrasound features of the skin
lesion. (a) A 3.5-cm, well-defined,
yellowish, firm nodule on the medial side
of the right ankle. (b) Diffuse eosinophilic
amorphous material in the entire dermis
(haematoxylin and eosin stain ×200).
(c) Thioflavin staining revealed an
apple-green birefringence, indicating
amyloid deposits within the dermis. (d)
Ultrasound image showing an ill-defined
heteroechoic mass in the dermis and
subcutaneous tissue, and hyperechoic
lineal foci with distal acoustic shadowing
suggesting calcification (arrow).
doi: 10.2340/00015555-2790
Acta Derm Venereol 2018; 98: 144–145
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.