Recurrent Ulceronecrotic Plaques And Nodules With Spontaneous Remission
Swoboda, S., Technau-Hafsi, K., May, A. M., Wolter, M., Kern, J. S., & Meiss, F. (2018). Recurrent ulceronecrotic plaques and nodules with spontaneous remission. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 16(9), 1155–1158. https://doi.org/10.1111/ddg.13626
View Original Source →Abstract
A 66-year-old patient presented with a five-week history of an indolent nodule in the right axilla and an ulceronecrotic plaque in the left nuchal region, which already showed signs of regression. Both lesions had occurred within a few weeks, had rapidly increased in size and shown spontaneous ulceration. A similar nodule had occurred on the right side of the neck a few years earlier and had spontaneously healed with scar formation. Six months earlier, the patient had been diagnosed with poorly differentiated adenosquamous lung cancer, pT2b pN2(3/39) cM0, stage IIIA (UICC), which had subsequently been treated by lower lobectomy. He was in good general health and denied any B symptoms. Recent follow-up imaging studies had yielded no evidence of recurrence or metastasis related to the NSCLC (non-small-cell lung cancer).
Case Details
Disease Location
Skin
Personal Characteristics
66-year-old patient. Six months before presentation, the patient had been diagnosed with poorly differentiated adenosquamous lung cancer, pt2b pn2(3/39) cm0, stage iiia. Which had subsequently been treated by lower lobectomy.
Clinical Characteristics
Presented with a five-week history of an indolent nodule in the right axilla and an ulceronecrotic plaque in the left nuchal region, which already showed signs of regression. Both lesions had occurred within a few weeks, had rapidly increased in size and shown spontaneous ulceration. A similar nodule had occurred on the right side of the neck a few years earlier and had spontaneously healed with scar formation. Clinical examination showed two ulcerated nodules (3–4 cm in diameter) with markedly elevated, violaceous/hemorrhagic borders in the left cervical region and the right axilla. The lesions were surrounded by a poorly demarcated erythema and coated with a fibrinous layer. Biopsies from the right axilla and the left cervical region showed acanthotic, partially parakeratotic epidermis and central ulceration. In the dermis, there was a dense polymorphous infiltrate that extended into the upper subcutis and consisted of numerous small and medium-sized lymphoid cells, multiple histiocytes, and eosinophils. The blast cells showed expression of CD30. The patient was diagnosed with an angioinvasive form of lymphomatoid papulosis. Disease recurrence was observed during follow-up after a few months
Remission Characteristics
The lesions healed (with typical atrophic scarring) within a few weeks