array:25 [
  "pii" => "S1578219021001001"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2021.02.015"
  "estado" => "S300"
  "fechaPublicacion" => "2021-05-01"
  "aid" => "2562"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2021;112:447-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731020305330"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2019.05.024"
      "estado" => "S300"
      "fechaPublicacion" => "2021-05-01"
      "aid" => "2562"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2021;112:447-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagn&#243;stico</span>"
        "titulo" => "Manchas contusiformes de aparici&#243;n progresiva en la cara y la espalda"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "447"
            "paginaFinal" => "448"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Bruise-like Spots Appearing Progressively on the Face and Back"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 450
                "Ancho" => 800
                "Tamanyo" => 157442
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxilina eosina<span class="elsevierStyleHsp" style=""></span> &#215;<span class="elsevierStyleHsp" style=""></span>20&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "R&#46; Ruiz-Villaverde, B&#46; Rueda-Villafranca, J&#46;C&#46; Ruiz-Carrascosa"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Ruiz-Villaverde"
              ]
              1 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Rueda-Villafranca"
              ]
              2 => array:2 [
                "nombre" => "J&#46;C&#46;"
                "apellidos" => "Ruiz-Carrascosa"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219021001001"
          "doi" => "10.1016/j.adengl.2021.02.015"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001001?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020305330?idApp=UINPBA000044"
      "url" => "/00017310/0000011200000005/v1_202105061359/S0001731020305330/v1_202105061359/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1578219021000068"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.01.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-05-01"
    "aid" => "2499"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2021;112:449-50"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
      "titulo" => "Isolated Bullae of the Scrotum in an 87 Year-Old-Man"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "449"
          "paginaFinal" => "450"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ampollas aisladas del escroto en un var&#243;n de 87 a&#241;os"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1000
              "Ancho" => 750
              "Tamanyo" => 127245
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Alves, A&#46; Pinho, J&#46;C&#46; Cardoso"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Alves"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Pinho"
            ]
            2 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Cardoso"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731020304221"
        "doi" => "10.1016/j.ad.2019.02.035"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020304221?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000068?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000005/v1_202105020833/S1578219021000068/v1_202105020833/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S1578219021000901"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.02.006"
    "estado" => "S300"
    "fechaPublicacion" => "2021-05-01"
    "aid" => "2549"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2021;112:441-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Granular Cell Tumor&#58; A Clinical Study of 81 Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "441"
          "paginaFinal" => "446"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tumor de c&#233;lulas granulares&#46; Estudio cl&#237;nico de 81 pacientes"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1630
              "Ancho" => 2500
              "Tamanyo" => 670106
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance of granular cell tumor in 4 patients&#58; A&#44; Incipient lesion on the tongue measuring 5&#8239;mm in diameter&#46; B&#44; Larger exophytic nodular lesion on the tongue&#46; The lesion is whitish in color owing to the underlying epithelial hyperplasia&#46; C&#44; Nodular erythematous lesion located on the trunk&#46; D&#44; Nodular yellowish lesion on the scalp with telangiectasias&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Marcoval, A&#46; Bauer-Alonso, C&#46; Llobera-Ris, C&#46; Moreno-V&#237;lchez, R&#46;M&#46; Pen&#237;n, J&#46; Bermejo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Marcoval"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Bauer-Alonso"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Llobera-Ris"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Moreno-V&#237;lchez"
            ]
            4 => array:2 [
              "nombre" => "R&#46;M&#46;"
              "apellidos" => "Pen&#237;n"
            ]
            5 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Bermejo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731020305159"
        "doi" => "10.1016/j.ad.2020.11.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020305159?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000901?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000005/v1_202105020833/S1578219021000901/v1_202105020833/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
    "titulo" => "Bruise-like Spots Appearing Progressively on the Face and Back"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "447"
        "paginaFinal" => "448"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "R&#46; Ruiz-Villaverde, B&#46; Rueda-Villafranca, J&#46;C&#46; Ruiz-Carrascosa"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "R&#46;"
            "apellidos" => "Ruiz-Villaverde"
            "email" => array:1 [
              0 => "ismenios@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Rueda-Villafranca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Ruiz-Carrascosa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatomia Patol&#243;gica&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Manchas contusiformes de aparici&#243;n progresiva en la cara y la espalda"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 450
            "Ancho" => 800
            "Tamanyo" => 157442
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin&#8211;eosin&#44; &#215;20&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man with a personal history of optic neuritis&#44; cerebellar infarct&#44; chronic moderate kidney failure&#44; dyslipidemia&#44; undergoing study for moderate pancytopenia with predominance of granulocyte and platelet series&#44; which had appeared 2 years earlier &#40;with a diagnosis of myelodysplastic syndrome&#41; was referred to the dermatology department with bruise-like spots that had gradually appeared 6 months earlier on the face and back&#44; with no associated pruritus&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed violaceous nodular plaques with poorly defined borders on the back&#44; predominantly on the upper third&#44; and on both cheeks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Palpation revealed no locoregional enlarged lymph nodes in the neck&#44; axillae&#44; or groin&#44; nor enlarged liver or spleen&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A lymphocytic infiltrate was observed throughout the thickness of the dermis&#44; in the form of converging patches with a Grenz band against the epidermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immune staining was positive for CD45&#44; CD4&#44; CD1a&#44; CD43&#44; CD56&#44; and CD123 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; negative for CD20&#44; CD138&#44; CD8&#44; and myeloperoxidase&#44; and weakly positive for CD33&#46; The Ki-67 labeling index was 40&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Analyses revealed the following&#58; Hb&#44; 11&#46;9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#59; l<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2180&#47;Ul&#59; platelets&#44; 78&#46;000&#47;Ul&#59; and B2 microglobulin&#44; 6&#46;7 &#40;N<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; The immune phenotype of the peripheral blood cells was as follows&#58; monocytes&#44; 16&#46;5&#37;&#59; lymphocytes&#44; 28&#46;16&#37;&#59; TCD3&#43; lymphocytes&#44; 22&#46;5&#37;&#59; CD4&#43;&#44; 15&#46;8&#37;&#59; CD8&#43;&#44; 5&#46;66&#37;&#59; B lymphocytes&#44; 0&#46;6&#37;&#59; NK cells&#44; 4&#46;4&#37;&#59; and neutrophils&#44; 53&#46;88&#37;&#46; All cells were mature CD10&#43; granulocytes&#46; No blast cells were detected&#46; Fine-needle aspiration of the bone marrow revealed normal bone-marrow cells with erythroid hyperplasia with no evident dysplastic signs of blood disease&#46; Imaging studies produced normal results &#40;abdominal ultrasound&#44; CT scan&#44; and PET-CT&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">What is your diagnosis&#63;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis</p><p id="par0030" class="elsevierStylePara elsevierViewall">Blastic plasmacytoid dendritic cell neoplasm &#40;WHO 2017&#41; or CD4&#43;&#47;CD56&#43; hematodermal neoplasm&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Study of disease extension revealed no involvement of the bone marrow&#46; Treatment was instated by protocol with cyclophosphamide&#44; vincristine&#44; doxorubicin&#44; and dexamethasone for frail patients over 45 years of age&#46; The clinical course was favorable after 3 months of treatment and no new lesions appeared&#46; The patient continues in periodic follow-up by the dermatology and hematology departments&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Different subtypes of lymphoma that express CD56 have emerged in recent years&#46; These include hematodermal CD4&#43;&#47;CD56&#43; or blastic plasmacytoid dendritic cell neoplasm&#46; This entity was first described by Adachi in 1994&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2001&#44; Chaperot<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> considered plamacytoid dendritic cells to be the precursor cells of this neoplasm and the entity acquired its definitive name in the 2005 WHO-EORTC update&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It consists of an aggressive hematologic disorder with a high incidence of cutaneous involvement and a major risk of leukemic cell dissemination&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It typically affects middle-aged and elderly men with no predominance of any race&#46; It rarely presents in children and only 12 pediatric cases have been reported to date&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It presents clinically as violaceous bruise-like spots or plaques&#44; which are painless in most cases&#44; with a predilection for the torso&#44; although the head and neck may also be involved&#44; as may the limbs&#46; Involvement of the lymph nodes is relatively common &#40;between 40&#37; and 50&#37; of cases&#41;&#44; although B symptoms are extraordinarily rare&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">From a histology point of view&#44; this variety of lymphoma does not present epidermotropism&#46; The lymphocytic infiltrate affects the dermis massively and sometimes goes deeper into the subcutaneous cellular tissue&#46; Necrosis and vascular invasion are not usual and mitotic figures tend to be present</p><p id="par0055" class="elsevierStylePara elsevierViewall">The immune-staining profile of most of these tumors is the following&#58; CD4&#43;&#47;CD56&#43;&#47;CD8&#8211;&#47;CD7&#8211;&#47;CD45&#43; and negative for B-cell markers and other T cells&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis should focus on lymphoproliferative disorders with primary and secondary skin involvement&#44; especially acute leukemia&#44; myelodysplastic syndromes&#44; and lymphoblastic lymphomas and nasal or extranasal NK lymphomas&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Prognosis is poor and the mean survival rate has been estimated in most series consulted to be approximately 14 months&#46; Dissemination to the bone marrow tends to be a rapid process once the skin lesions appear&#46; For this reason&#44; most of these cases must be treated at multidisciplinary centers and with aggressive regimens that consider this entity as equivalent to an acute leukemia&#46; In cases where response is favorable&#44; development of residual hyperpigmentation is typical&#44; as is recurrence if therapy is interrupted&#46; A good response has been reported following use of the combined protocol of chemotherapy and radiation therapy followed by allogenic stem-cell transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Medical History"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Physical Examination"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Histopathology"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Additional Tests"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "What is your diagnosis&#63;"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Clinical Course and Treatment"
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Comment"
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of Interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-02-20"
    "fechaAceptado" => "2019-05-22"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz-Villaverde R&#44; Rueda-Villafranca B&#44; Ruiz-Carrascosa JC&#46; Manchas contusiformes de aparici&#243;n progresiva en la cara y la espalda&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;447&#8211;448&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:6 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 665
            "Ancho" => 500
            "Tamanyo" => 54473
          ]
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 450
            "Ancho" => 800
            "Tamanyo" => 157442
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin&#8211;eosin&#44; &#215;20&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 449
            "Ancho" => 800
            "Tamanyo" => 119208
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; CD45&#46; B&#44; CD1a&#46; C&#44; CD43&#46; D&#44; CD123&#46; E&#44; CD56&#46; F&#44; CD4 &#40;&#215;2&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High expression of CD56 &#40;N-CAM&#41; in a patient with cutaneous CD4-positive lymphoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Adachi"
                            1 => "K&#46; Maeda"
                            2 => "M&#46; Takekawa"
                            3 => "Y&#46; Hinoda"
                            4 => "K&#46; Imai"
                            5 => "S&#46; Sugiyama"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ajh.2830470406"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Hematol"
                        "fecha" => "1994"
                        "volumen" => "47"
                        "paginaInicial" => "278"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7526680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of a leukemic counterpart of the plasmacytoid dendritic cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Chaperot"
                            1 => "N&#46; Bendriss"
                            2 => "O&#46; Manches"
                            3 => "R&#46; Gressin"
                            4 => "M&#46; Maynadie"
                            5 => "F&#46; Trimoreau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood.v97.10.3210"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2001"
                        "volumen" => "97"
                        "paginaInicial" => "3210"
                        "paginaFinal" => "3217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11342451"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "WHO-EORTC classification for cutaneous lymphomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Willemze"
                            1 => "E&#46;S&#46; Jaffe"
                            2 => "G&#46; Burg"
                            3 => "L&#46; Cerroni"
                            4 => "E&#46; Berti"
                            5 => "S&#46;H&#46; Swerdlow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2004-09-3502"
                      "Revista" => array:7 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2005"
                        "volumen" => "105"
                        "paginaInicial" => "3768"
                        "paginaFinal" => "3785"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692063"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673604156900"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CD4&#43;&#47;CD56&#43; haematodermic neoplasm&#58; a preculsor haematological neoplasm that frequently first presents in the skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Mart&#237;n"
                            1 => "M&#46; Nicolau"
                            2 => "A&#46; Gal&#225;n"
                            3 => "A&#46; Ferr&#225;ndez-Izquierdo"
                            4 => "A&#46;M&#46; Ferrer"
                            5 => "E&#46; Jord&#225;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatology Venereol"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "1129"
                        "paginaFinal" => "1132"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673616313575"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood CD4&#43;&#47;CD56&#43; hematodermic neoplasm&#58; case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ruggiero"
                            1 => "P&#46; Maurizi"
                            2 => "L&#46;M&#46; Larocca"
                            3 => "A&#46; Arlotta"
                            4 => "R&#46; Riccardi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Haematologica"
                        "fecha" => "2006"
                        "volumen" => "91"
                        "paginaInicial" => "ECR48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17194654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leukemia cutis&#58; a report of 17 cases and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Mart&#237;nez-Lebor&#225;ns"
                            1 => "A&#46;M&#46; Victoria-Mart&#237;nez"
                            2 => "J&#46;L&#46; Torregrosa-Calatayud"
                            3 => "V&#46; Alegre de Miquel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2016.02.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2016"
                        "volumen" => "107"
                        "paginaInicial" => "e65"
                        "paginaFinal" => "e69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27210518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is CD4&#43;CD56&#43; malignancy and how should it be treated&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Reimer"
                            1 => "T&#46; R&#252;diger"
                            2 => "D&#46; Kraemer"
                            3 => "V&#46; Kunzmann"
                            4 => "F&#46; Weissinger"
                            5 => "A&#46; Zettl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bmt.1704215"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant"
                        "fecha" => "2003"
                        "volumen" => "32"
                        "paginaInicial" => "637"
                        "paginaFinal" => "646"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13130309"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011200000005/v1_202105020833/S1578219021001001/v1_202105020833/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6154"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case for Diagnosis"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000005/v1_202105020833/S1578219021001001/v1_202105020833/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001001?idApp=UINPBA000044"
]
Share
Journal Information
Vol. 112. Issue 5.
Pages 447-448 (May 2021)
Visits
4540
Vol. 112. Issue 5.
Pages 447-448 (May 2021)
Case for Diagnosis
Open Access
Bruise-like Spots Appearing Progressively on the Face and Back
Manchas contusiformes de aparición progresiva en la cara y la espalda
Visits
4540
R. Ruiz-Villaverdea,
Corresponding author
ismenios@hotmail.com

Corresponding author.
, B. Rueda-Villafrancab, J.C. Ruiz-Carrascosaa
a Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Anatomia Patológica, Hospital Universitario San Cecilio, Granada, Spain
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text
Medical History

A 76-year-old man with a personal history of optic neuritis, cerebellar infarct, chronic moderate kidney failure, dyslipidemia, undergoing study for moderate pancytopenia with predominance of granulocyte and platelet series, which had appeared 2 years earlier (with a diagnosis of myelodysplastic syndrome) was referred to the dermatology department with bruise-like spots that had gradually appeared 6 months earlier on the face and back, with no associated pruritus.

Physical Examination

The physical examination revealed violaceous nodular plaques with poorly defined borders on the back, predominantly on the upper third, and on both cheeks (Fig. 1). Palpation revealed no locoregional enlarged lymph nodes in the neck, axillae, or groin, nor enlarged liver or spleen.

Figure 1
(0.05MB).
Histopathology

A lymphocytic infiltrate was observed throughout the thickness of the dermis, in the form of converging patches with a Grenz band against the epidermis (Fig. 2). Immune staining was positive for CD45, CD4, CD1a, CD43, CD56, and CD123 (Fig. 3), negative for CD20, CD138, CD8, and myeloperoxidase, and weakly positive for CD33. The Ki-67 labeling index was 40%.

Figure 2.

Hematoxylin–eosin, ×20.

(0.15MB).
Figure 3.

A, CD45. B, CD1a. C, CD43. D, CD123. E, CD56. F, CD4 (×2).

(0.11MB).
Additional Tests

Analyses revealed the following: Hb, 11.9g/dL; l=2180/Ul; platelets, 78.000/Ul; and B2 microglobulin, 6.7 (N<5mg/dL). The immune phenotype of the peripheral blood cells was as follows: monocytes, 16.5%; lymphocytes, 28.16%; TCD3+ lymphocytes, 22.5%; CD4+, 15.8%; CD8+, 5.66%; B lymphocytes, 0.6%; NK cells, 4.4%; and neutrophils, 53.88%. All cells were mature CD10+ granulocytes. No blast cells were detected. Fine-needle aspiration of the bone marrow revealed normal bone-marrow cells with erythroid hyperplasia with no evident dysplastic signs of blood disease. Imaging studies produced normal results (abdominal ultrasound, CT scan, and PET-CT).

What is your diagnosis?

Diagnosis

Blastic plasmacytoid dendritic cell neoplasm (WHO 2017) or CD4+/CD56+ hematodermal neoplasm.

Clinical Course and Treatment

Study of disease extension revealed no involvement of the bone marrow. Treatment was instated by protocol with cyclophosphamide, vincristine, doxorubicin, and dexamethasone for frail patients over 45 years of age. The clinical course was favorable after 3 months of treatment and no new lesions appeared. The patient continues in periodic follow-up by the dermatology and hematology departments.

Comment

Different subtypes of lymphoma that express CD56 have emerged in recent years. These include hematodermal CD4+/CD56+ or blastic plasmacytoid dendritic cell neoplasm. This entity was first described by Adachi in 1994.1 In 2001, Chaperot2 considered plamacytoid dendritic cells to be the precursor cells of this neoplasm and the entity acquired its definitive name in the 2005 WHO-EORTC update.3 It consists of an aggressive hematologic disorder with a high incidence of cutaneous involvement and a major risk of leukemic cell dissemination.4

It typically affects middle-aged and elderly men with no predominance of any race. It rarely presents in children and only 12 pediatric cases have been reported to date.5 It presents clinically as violaceous bruise-like spots or plaques, which are painless in most cases, with a predilection for the torso, although the head and neck may also be involved, as may the limbs. Involvement of the lymph nodes is relatively common (between 40% and 50% of cases), although B symptoms are extraordinarily rare.6

From a histology point of view, this variety of lymphoma does not present epidermotropism. The lymphocytic infiltrate affects the dermis massively and sometimes goes deeper into the subcutaneous cellular tissue. Necrosis and vascular invasion are not usual and mitotic figures tend to be present

The immune-staining profile of most of these tumors is the following: CD4+/CD56+/CD8–/CD7–/CD45+ and negative for B-cell markers and other T cells.5

The differential diagnosis should focus on lymphoproliferative disorders with primary and secondary skin involvement, especially acute leukemia, myelodysplastic syndromes, and lymphoblastic lymphomas and nasal or extranasal NK lymphomas.6

Prognosis is poor and the mean survival rate has been estimated in most series consulted to be approximately 14 months. Dissemination to the bone marrow tends to be a rapid process once the skin lesions appear. For this reason, most of these cases must be treated at multidisciplinary centers and with aggressive regimens that consider this entity as equivalent to an acute leukemia. In cases where response is favorable, development of residual hyperpigmentation is typical, as is recurrence if therapy is interrupted. A good response has been reported following use of the combined protocol of chemotherapy and radiation therapy followed by allogenic stem-cell transplant.7

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
M. Adachi, K. Maeda, M. Takekawa, Y. Hinoda, K. Imai, S. Sugiyama, et al.
High expression of CD56 (N-CAM) in a patient with cutaneous CD4-positive lymphoma.
Am J Hematol, 47 (1994), pp. 278-282
[2]
L. Chaperot, N. Bendriss, O. Manches, R. Gressin, M. Maynadie, F. Trimoreau, et al.
Identification of a leukemic counterpart of the plasmacytoid dendritic cells.
Blood, 97 (2001), pp. 3210-3217
[3]
R. Willemze, E.S. Jaffe, G. Burg, L. Cerroni, E. Berti, S.H. Swerdlow, et al.
WHO-EORTC classification for cutaneous lymphomas.
Blood, 105 (2005), pp. 3768-3785
[4]
J. Martín, M. Nicolau, A. Galán, A. Ferrández-Izquierdo, A.M. Ferrer, E. Jordá, et al.
CD4+/CD56+ haematodermic neoplasm: a preculsor haematological neoplasm that frequently first presents in the skin.
J Eur Acad Dermatology Venereol, 20 (2006), pp. 1129-1132
[5]
A. Ruggiero, P. Maurizi, L.M. Larocca, A. Arlotta, R. Riccardi.
Childhood CD4+/CD56+ hematodermic neoplasm: case report and review of the literature.
Haematologica, 91 (2006), pp. ECR48
[6]
L. Martínez-Leboráns, A.M. Victoria-Martínez, J.L. Torregrosa-Calatayud, V. Alegre de Miquel.
Leukemia cutis: a report of 17 cases and a review of the literature.
Actas Dermosifiliogr., 107 (2016), pp. e65-e69
[7]
P. Reimer, T. Rüdiger, D. Kraemer, V. Kunzmann, F. Weissinger, A. Zettl, et al.
What is CD4+CD56+ malignancy and how should it be treated?.
Bone Marrow Transplant, 32 (2003), pp. 637-646

Please cite this article as: Ruiz-Villaverde R, Rueda-Villafranca B, Ruiz-Carrascosa JC. Manchas contusiformes de aparición progresiva en la cara y la espalda. Actas Dermosifiliogr. 2021;112:447–448.

Copyright © 2020. AEDV
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?