An enlarging, ulcerated scalp nodule
نویسندگان
چکیده
A 77-year-old woman with no previous medical hist ory presented with an 18-month history of an enlarging painless scalp nodule, intermittent fevers, fatigue, and 2-kg unintentional weight loss. The patient reported progressive enlargement and ulceration of the skin lesion despite 2 injections of intralesional triamcinolone. Her physical examination was notable for a 10-cm ulcerating occipital scalp nodule with multiple smaller adjacent dermal nodules (Fig 1). Bilateral anterior cervical and right supraclavicular lymphadenopathy was palpable. Skin biopsy found a diffuse infiltrate of lymphocytes, eosinophils, and plasma cells with scattered cells characterized by large vesicular nuclei and prominent nucleoli (black arrows) and binucleate cells (red arrow) (Fig 2). Large atypical cells were positive for CD30, CD15, and MUM1 and weakly positive for PAX-5, whereas ALK, OCT-2, and BOB.1 were all negative.
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