Case for Diagnosis
Slow-Growing Nodule on the Lower Lip
Nódulo de crecimiento progresivo localizado en el labio inferior
C. Prada-García
, M. Lamoca-Martín, M.Á. Rodríguez-Prieto
Autor para correspondencia
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Prada-García, M. Lamoca-Martín, M.Á. Rodríguez-Prieto" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Prada-García" "email" => array:1 [ 0 => "caminoprada@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Lamoca-Martín" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulo de crecimiento progresivo localizado en el labio inferior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 534 "Ancho" => 710 "Tamanyo" => 198288 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin ×4.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 52-year old patient with no relevant past medical history presented with an asymptomatic, slow-growing, homogenous nodular lesion on the lower lip that had appeared 10 years earlier. The patient was unable to relate the onset of the lesion to any event and had received no previous treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had a well-defined pinkish-red nodule with superficial telangiectasia; the lesion infiltrated the full thickness of the lip, was painless on palpation, and measured 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Hematoxylin-eosin staining revealed the presence of lymphoid cell proliferation, consisting mainly of plasma cells in different stages of maturation, with involvement of striated muscle tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and deposition of amorphous, homogeneous, eosinophilic, Congo red–positive material compatible with amyloid fibrils. Immunohistochemistry revealed κ light chain restriction but was negative for λ light chain and for CD20 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> A and B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The staging workup included laboratory tests (complete blood count, biochemistry, β2-microglobulin, and protein electrophoresis), myelogram, bone marrow biopsy, 24-hour urinary light chain excretion, bone marrow blood count, and bone marrow flow cytometry. The results of all studies were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Primary cutaneous plasmacytoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was excised and the patient is attending periodic check-ups with no recurrence.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Malignant plasma cell tumors are usually systemic (multiple myeloma) and less often localized (solitary plasmacytoma). Localized tumors include solitary plasmacytomas of bone and extramedullary plasmacytomas. In 60% to 80% of cases extramedullary plasmacytomas are located in the upper respiratory tract. Primary skin lesions are very rare.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Primary cutaneous plasmacytoma is included in the 2005 classification of the European Organization for Research and Treatment of Cancer (EORTC) among the marginal zone B-cell lymphomas,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and originates from the clonal proliferation of immunoglobulin-secreting plasma cells in the absence of underlying multiple myeloma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–5</span></a> It was first described by Stout and Frerichs in 1949<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and accounts for 4% of extramedullary plasmacytomas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Mean age at diagnosis is 60 years, with a male-female ratio of 4:1.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6</span></a> Clinically it presents as a slow-growing papule, plaque, or erythematous-violaceous nodule<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> usually located on the trunk or in the facial region.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It can take the form of a solitary tumor (62%) or may involve multiple sites (38%).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Histopathology shows a nonepidermotropic dermal infiltrate of plasma cells at different stages of maturation. Immunohistochemistry is usually positive for CD79a, CD38, and CD138 and negative for CD20 and leukocyte common antigen; monotypic expression of immunoglobulin light chains is common.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Since amyloid deposits are more often associated with secondary plasmacytomas, their presence should raise suspicion of an extracutaneous origin.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Diagnosis is based on clinical, histopathologic, and immunohistochemical findings, and multiple myeloma must be ruled out by laboratory, radiologic, and bone marrow studies.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Differential diagnosis is mainly with secondary cutaneous plasmacytoma, mucosal extramedullary plasmacytoma with secondary skin involvement, other primary B-cell lymphomas, and infectious diseases with significant infiltration of plasma cells, such as syphilis and Lyme disease.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Solitary plasmacytoma progresses to multiple myeloma in one third of cases<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and cases with multiple or large lesions have the worst prognosis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The treatment for solitary tumors is surgery, which may be combined with radiation therapy and intralesional corticosteroid therapy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a><span class="elsevierStyleSup">.</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Chemotherapy should be considered when multiple lesions are present.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</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" => "Diagnosis" ] 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 "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Prada-García C, et al. Nódulo de crecimiento progresivo localizado en el labio inferior. Actas Dermosifiliogr.2012;103:325-6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 533 "Ancho" => 711 "Tamanyo" => 108094 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nodule of 1.5<span class="elsevierStyleHsp" style=""></span>cm diameter infiltrating the lower lip.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 534 "Ancho" => 710 "Tamanyo" => 198288 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin ×4.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 257 "Ancho" => 710 "Tamanyo" => 100322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry. A, λ light chain ×40; B, κ light chain ×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous plasmacy-toma: Report of a case with review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.M. Muscardin" 1 => "A. Pulsoni" 2 => "L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 16 | 28 |
| 2024 Octubre | 93 | 45 | 138 |
| 2024 Septiembre | 92 | 33 | 125 |
| 2024 Agosto | 126 | 63 | 189 |
| 2024 Julio | 112 | 40 | 152 |
| 2024 Junio | 113 | 41 | 154 |
| 2024 Mayo | 93 | 30 | 123 |
| 2024 Abril | 81 | 25 | 106 |
| 2024 Marzo | 82 | 44 | 126 |
| 2024 Febrero | 80 | 43 | 123 |
| 2024 Enero | 62 | 43 | 105 |
| 2023 Diciembre | 68 | 31 | 99 |
| 2023 Noviembre | 93 | 36 | 129 |
| 2023 Octubre | 72 | 47 | 119 |
| 2023 Septiembre | 74 | 37 | 111 |
| 2023 Agosto | 50 | 26 | 76 |
| 2023 Julio | 83 | 55 | 138 |
| 2023 Junio | 65 | 34 | 99 |
| 2023 Mayo | 79 | 43 | 122 |
| 2023 Abril | 78 | 35 | 113 |
| 2023 Marzo | 77 | 52 | 129 |
| 2023 Febrero | 55 | 33 | 88 |
| 2023 Enero | 51 | 57 | 108 |
| 2022 Diciembre | 62 | 55 | 117 |
| 2022 Noviembre | 22 | 27 | 49 |
| 2022 Octubre | 24 | 33 | 57 |
| 2022 Septiembre | 33 | 35 | 68 |
| 2022 Agosto | 25 | 38 | 63 |
| 2022 Julio | 22 | 46 | 68 |
| 2022 Junio | 24 | 34 | 58 |
| 2022 Mayo | 85 | 35 | 120 |
| 2022 Abril | 93 | 41 | 134 |
| 2022 Marzo | 64 | 62 | 126 |
| 2022 Febrero | 57 | 35 | 92 |
| 2022 Enero | 93 | 52 | 145 |
| 2021 Diciembre | 43 | 39 | 82 |
| 2021 Noviembre | 72 | 47 | 119 |
| 2021 Octubre | 66 | 74 | 140 |
| 2021 Septiembre | 47 | 40 | 87 |
| 2021 Agosto | 37 | 31 | 68 |
| 2021 Julio | 26 | 21 | 47 |
| 2021 Junio | 26 | 40 | 66 |
| 2021 Mayo | 37 | 40 | 77 |
| 2021 Abril | 93 | 83 | 176 |
| 2021 Marzo | 62 | 42 | 104 |
| 2021 Febrero | 58 | 47 | 105 |
| 2021 Enero | 21 | 30 | 51 |
| 2020 Diciembre | 33 | 14 | 47 |
| 2020 Noviembre | 22 | 21 | 43 |
| 2020 Octubre | 22 | 17 | 39 |
| 2020 Septiembre | 31 | 44 | 75 |
| 2020 Agosto | 28 | 62 | 90 |
| 2020 Julio | 33 | 22 | 55 |
| 2020 Junio | 35 | 26 | 61 |
| 2020 Mayo | 35 | 18 | 53 |
| 2020 Abril | 30 | 27 | 57 |
| 2020 Marzo | 38 | 25 | 63 |
| 2020 Febrero | 1 | 9 | 10 |
| 2020 Enero | 4 | 14 | 18 |
| 2019 Diciembre | 4 | 8 | 12 |
| 2019 Noviembre | 4 | 4 | 8 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 2 | 6 |
| 2019 Agosto | 4 | 3 | 7 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 4 | 18 | 22 |
| 2019 Mayo | 4 | 10 | 14 |
| 2019 Abril | 2 | 13 | 15 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 2 | 2 | 4 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 2 | 5 | 7 |
| 2018 Noviembre | 3 | 2 | 5 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 74 | 3 | 77 |
| 2018 Enero | 74 | 9 | 83 |
| 2017 Diciembre | 101 | 6 | 107 |
| 2017 Noviembre | 59 | 8 | 67 |
| 2017 Octubre | 64 | 6 | 70 |
| 2017 Septiembre | 73 | 5 | 78 |
| 2017 Agosto | 62 | 14 | 76 |
| 2017 Julio | 57 | 13 | 70 |
| 2017 Junio | 73 | 36 | 109 |
| 2017 Mayo | 68 | 10 | 78 |
| 2017 Abril | 59 | 11 | 70 |
| 2017 Marzo | 55 | 21 | 76 |
| 2017 Febrero | 55 | 11 | 66 |
| 2017 Enero | 55 | 6 | 61 |
| 2016 Diciembre | 71 | 9 | 80 |
| 2016 Noviembre | 70 | 17 | 87 |
| 2016 Octubre | 73 | 20 | 93 |
| 2016 Septiembre | 66 | 14 | 80 |
| 2016 Agosto | 89 | 23 | 112 |
| 2016 Julio | 75 | 20 | 95 |
| 2016 Junio | 7 | 18 | 25 |
| 2016 Mayo | 7 | 8 | 15 |
| 2016 Abril | 8 | 1 | 9 |
| 2016 Marzo | 9 | 2 | 11 |
| 2016 Febrero | 12 | 5 | 17 |
| 2016 Enero | 9 | 3 | 12 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 24 | 7 | 31 |
| 2015 Octubre | 20 | 4 | 24 |
| 2015 Septiembre | 12 | 4 | 16 |
| 2015 Agosto | 13 | 7 | 20 |
| 2015 Julio | 87 | 8 | 95 |
| 2015 Junio | 63 | 7 | 70 |
| 2015 Mayo | 112 | 12 | 124 |
| 2015 Abril | 70 | 10 | 80 |
| 2015 Marzo | 69 | 9 | 78 |
| 2015 Febrero | 66 | 20 | 86 |
| 2015 Enero | 95 | 13 | 108 |
| 2014 Diciembre | 80 | 7 | 87 |
| 2014 Noviembre | 60 | 14 | 74 |
| 2014 Octubre | 108 | 16 | 124 |
| 2014 Septiembre | 65 | 9 | 74 |
| 2014 Agosto | 84 | 18 | 102 |
| 2014 Julio | 105 | 25 | 130 |
| 2014 Junio | 107 | 14 | 121 |
| 2014 Mayo | 131 | 27 | 158 |
| 2014 Abril | 36 | 2 | 38 |
| 2014 Marzo | 31 | 6 | 37 |
| 2014 Febrero | 27 | 8 | 35 |
| 2014 Enero | 33 | 10 | 43 |
| 2013 Diciembre | 35 | 7 | 42 |
| 2013 Noviembre | 26 | 5 | 31 |
| 2013 Octubre | 12 | 5 | 17 |
| 2013 Septiembre | 27 | 3 | 30 |
| 2013 Agosto | 22 | 5 | 27 |
| 2013 Julio | 16 | 11 | 27 |
| 2013 Junio | 15 | 10 | 25 |
| 2013 Mayo | 9 | 7 | 16 |
| 2013 Abril | 15 | 8 | 23 |
| 2013 Marzo | 16 | 12 | 28 |
| 2013 Febrero | 21 | 4 | 25 |
| 2013 Enero | 17 | 7 | 24 |
| 2012 Diciembre | 24 | 4 | 28 |
| 2012 Agosto | 0 | 1 | 1 |
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