P8598Nodule on the right leg with rapid growth over last 2 weeks: A difficultdiagnosis

Mar�ıa Salazar-Nievas, MD, San Cecilio Hospital, Granada, Spain; Juan M. Rubio-L�opez, MD, Jaen City Hospital Complex, Ja�en, Spain; Vicente Crespo-Lora, MD,San Cecilio Hospital, Granada, Spain

Background: The diagnostic and therapeutic management of rapidly growing skinnodules is not always easy. Often, the dermatologist makes a diagnosis that does notcorrespond with subsequent pathologic findings. It is important to do a completedifferential diagnosis, and send the patient to a preferred surgery.

Case report: Male 82-year-old, with no personal or family history, consulted becauseof the appearance of a pink colored nodule on the right leg, asymptomatic and withrapid growth over last 2 weeks. Examination revealed a skin lesion of 4 to 7 cm indiameter, with sharp borders, strong consistency, nodular, ulcerated, and pinkcolored. With the suspicion of squamous cell carcinoma versus melanoma, surgeryis decided. The anatomicepathologic study concluded that it is a primary cutaneousanaplastic large cell lymphoma. Following this finding, the patient is referred tooncology for palliative radiotherapy.

Conclusion: Primary cutaneous T-cell lymphomas (CTCLs) are part of a group of rarenon-Hodgkin lymphomas that arise from the T-cell type lymphocytes. Included inthis group is primary cutaneous anaplastic large cell lymphoma. Anaplastic large celllymphoma (ALCL) comprises only about 3% of all lymphomas in adults and between10% and 30% of all lymphomas in children. It is an indolent, or slow growing,lymphoma and is associated with a rare condition called lymphomatoid papulois(LyP), which, while classified as a lymphoma, always goes away by itself. Thetreatment for primary cutaneous ALCL is generally nonaggressive and the prognosisis usually excellent.

AB124

cial support: None identified.

Commer

P7531Primary cutaneous small to medium sized pleomorphic T-cell lymphoma:A clinical case review

Sarah Croft, DO, MS, Largo Medical Center, Largo, FL, United States; KrinaChavda, DO, Largo Medical Center, Largo, FL, United States; Ralph Fiore II, DO,Largo Medical Center, Largo, FL, United States

Cutaneous T-cell lymphoma (CTCL) represents a group of lymphoproliferativedisorders characterized by neoplastic T lymphocytes within the skin. Primarycutaneous small to medium sized pleomorphic T-cell lymphoma (PCSM-TCL) is aprovisional entry into the 2008 WHO-EROTC classification of CTCL with anestimated frequency at 2% of all CTCLs. These lesions can present as solitarynodules on the head or neck and have distinct histologic characteristics that lend toits differentiation from the other primary cutaneous T-cell lymphoma, unspecifiedtype. Here, we present a 36-year-old man with a 1-month history of persistentinflamed nodular lesion on his right cheek. Histopathologic analysis confirmeddiagnosis of this rare disease entity; however, given the evolving criterion for diseaseclassification, diagnosis and treatment for PCSM-TCL can often be delayed. This casereview highlights the intricate complexities of’PCSM-TCL for diagnosis and optimaltreatment recommendations with attention to modifying the current classificationsystem for PCSM-TCL as a distinct disease entity.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P8293Primary cutaneous anaplastic large cell lymphoma treated with PUVA

Adam Perry, MD, Medical University of South Carolina, Charleston, SC, UnitedStates; John Maize, Sr, MD, Medical University of South Carolina, Charleston, SC,United States; Julie Rembold, MD, Medical University of South Carolina,Charleston, SC, United States

Introduction: Numerous treatment modalities have been tried for primary cuta-neous anaplastic large cell lymphoma (PCALCL). Current consensus recommenda-tions by major international cutaneous lymphoma organizations suggest usingsurgical excision or radiation therapy for isolated lesions, methotrexate formultifocal lesions, and chemotherapy for extracutaneous disease. All of thesetreatment modalities have high recurrence rates ranging from 41% for radiationtherapy to 62% for chemotherapy. There remains a need for additional treatmentoptions. Herein, we report a case of PCALCL treated with PUVA.

Case report: The patient was diagnosed with PCALCL in 2001 at 67 years of age.From 2001 to 2009, she was treated with various modalities, including cytoxan andvinblastine, local radiation therapy, and PUVA. She presented to our clinic in 2009.At that time, she had a large nodule on her right eyebrow and was restarted on PUVAtwice weekly to her face. After 5 weeks of PUVA, the nodule resolved, and hertreatments were tapered to twice monthly. At the lower frequency, she developed afew small papules 5months later. These lesions resolved by increasing the frequencyto twice weekly. The original nodule on her right eyebrow never recurred. Over 2years, she had 2 recurrences when the treatments were tapered. Each recurrenceresponded to increasing the frequency back to twice weekly. The patient thendeveloped a 1.5-cm nodule on her right cheek that was recalcitrant to twice weeklyPUVA. The area was ultimately treated successfully with radiation therapy. Sheremained lesion-free for 4 months until she developed nodules on her left forearmand left leg, Her treatments were then expanded to include her arms and legs. Thesenodules resolved over a period of weeks on twice weekly PUVAwith no new lesionsarising thus far.

Discussion: To our knowledge this is only the second reported case of using PUVAfor PCALCL and is the first reported case of using PUVA as monotherapy for PCALCL.Georgi et al reported a patient who was simultaneously treated with PUVA andradiation therapy. This patient achieved a complete response but had a recurrence 6months later. While our patient had a few recurrences during her 3-year treatmentcourse with PUVA, only 1 nodule failed to respond to increasing the frequency ofPUVA treatments. PUVA shows promise as a possible treatment option for patientswith PCALCL, but more research is certainly needed.

cial support: None identified.

Commer

P8113Pulmonary complications of liposomal doxorubicin in a patient with anadvanced stage of folliculotropic mycosis fungoides

Diana Menis, Servicio de Dermatologia Hospital 12 de Octubre, Madrid, Spain;Carlos Zarco Olivo, Servicio de Dermatologia Hospital 12 de Octubre, Madrid,Spain; Francisco Vanaclocha Sebasti�an, Servicio de Dermatologia Hospital 12 deOctubre, Madrid, Spain; Jimena Sanz Bueno, Servicio de Dermatologia Hospital12 de Octubre, Madrid, Spain; Lidia Maro~nas Jim�enez, Servicio de DermatologiaHospital 12 de Octubre, Madrid, Spain; Maria del Mar Galera Lopez, Servicio deInfecciosas Hospital 12 de Octubre, Madrid, Spain; Victoria Alegria Landa,Servicio de Dermatologia Hospital 12 de Octubre, Madrid, Spain

Introduction: liposomal doxorubicin is part of the armamentarium used inadvanced/recalcitrant primary cutaneous T-cell lymphomas (CTCLs). Respiratorycomplications with this drug are extremely rare and its management requires rapididentification and drug discontinuation.

Case report: We present the case of a 55-year-old man with an advanced stage offolliculotropic mycosis fungoides, that after several infusions of liposomal doxoru-bicin (20 mg/m2), began with dyspnea and dry cough that rapidly evolved toprogressive respiratory failure. We performed a chest CT scan that revealed bilateralinterstitial infiltrates and ground-glass opacities.We suspended the next infusion andstarted treatment with meropenem 3 g/day, vancomicina 2 g/day, and cotrimoxazol100/20 mg/kg/day during 15 days and methylprednisolone 80 mg/day during 10days with gradually tapering. All microbiologic tests were negative. The bronchoal-veolar lavage fluid showed macrophage and lymphocyte predominance. Hepresented a rapid clinical and radiologic improvement. The clinical course andlaboratory data indicated that an interstitial pneumonitis induced by liposomaldoxorubicin was the most probable diagnosis.

Discussion: The most frequent adverse effects of liposomal doxorubicin are nauseaand vomiting (73%), leukopenia (70%), alopecia (66%), neutropenia (46%), astheniaand fatigue (46%), stomatitis and mucositis (42%), thrombocytopenia (31%), andanemia (30%). The respiratory complications, like pleural effusion and pneumonitis,are extremely rare. In the literature, there are many cases of interstitial pneumonitisrelated to the association of doxorubicin, cyclophosphamide, vincristine, andprednisone (CHOP), few cases associated to pegylated liposomal doxorubicin,although no cases have been publishedwith the nonpegylated form of the liposomaldoxorubicin, like in our case. Drug-induced interstitial pneumonitis should be takeninto consideration in the differential diagnosis of otherwise unexplained ground-glass lung lesions in a patient under treatment with liposomal doxorubicin.

cial support: None identified.

Commer

MAY 2014