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predominantly positive for CD20 &#40;with a 2&#58;1 ratio with CD3&#41; and negative for CD38 and CD138 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; C and D&#41;&#46; The few associated plasma cells did not show &#955;&#47;&#954; light chain restriction&#46; Genetic analysis identified positive monoclonal IgH &#40;FR1 region&#41; and biclonal IgH &#40;FR3 region&#41; rearrangements&#44; confirming the diagnosis as cutaneous infiltration by lymphoplasmacytic lymphoma&#47;WM&#46; Immunohistochemistry for IgM was not performed on the skin biopsy because that study is not available at our hospital&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical progression &#40;asthenia&#44; joint pain&#44; weight loss&#44; sweating&#41; was observed during 2015&#44; with progressive anemia &#40;hemoglobin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and an increase in the size of the previously present lymph nodes&#46; It was therefore decided to start systemic treatment with 6 cycles of rituximab plus bendamustine at standard doses&#46; In addition&#44; topical methylprednisolone was prescribed for the skin lesions&#46; A month after completing the chemotherapy regimen&#44; the skin lesions had disappeared&#46; The patient reported an improvement in his general wellbeing&#44; and blood test results &#40;hemoglobin &#62;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and radiological findings had improved&#46; At the time of writing&#44; the patient has no general or cutaneous symptoms and continues on follow-up by the hematology department &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">WM is a rare B-cell lymphoproliferative disorder of unknown etiology&#46; It is characterized by a proliferation of lymphoplasmacytic cells in the bone marrow and a monoclonal IgM peak in peripheral blood&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Skin involvement occurs in 5&#37; of patients with WM&#46; According to the classification by Libow et al&#46;&#44; 2<span class="elsevierStyleHsp" style=""></span>types of skin lesion can develop<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a>&#58; neoplastic lesions due to direct infiltration of the skin by the lymphoplasmacytic cells&#59; and nonneoplastic lesions&#44; secondary to the paraproteinemia&#46; The nonneoplastic lesions are more common and are divided into 3 subtypes&#58; those caused by a hyperviscosity syndrome &#40;acral purpura&#44; mucosal bleeding&#44; peripheral edema&#41;&#59; those associated with cryoglobulinemia &#40;acral cyanosis&#44; Raynaud phenomenon&#44; cold hypersensitivity&#44; livedo reticularis&#44; leukocytoclastic vasculitis&#41;&#59; and those related to the specific paraproteins &#40;IgM bullous dermatosis&#44; macroglobulinemia cutis&#44; and erythematous papules associated with WM&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The neoplastic skin lesions&#44; due to direct infiltration of the skin by the lymphoplasmacytic cells&#44; are less common&#46; Only around 20 cases have been reported in the literature&#44; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;8</span></a> and their diagnosis in daily practice is very rare&#46; They present clinically as mildly desquamating&#44; slightly infiltrated erythematous plaques localized mainly symmetrically on the face and ears and also on the chest&#44; flanks&#44; and back&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;8</span></a> They can arise early in the course of the disease&#44; but it should be stressed that their presence does not worsen the prognosis&#46; Cells found in these skin lesions are from the lymphoplasmacytic cell line&#46; They are positive for B-cell markers &#40;CD19&#44; CD20&#44; CD22&#41; and negative for plasma cell markers &#40;CD38 and CD138&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The distinction between cases of lymphoplasmacytic lymphoma&#47;WM and marginal zone lymphoma &#40;MZL&#41; with intense plasmacytic differentiation can be difficult in some cases because of the degree of clinical-pathologic overlap&#46; Investigation of cyclin D1 &#40;positive in MZL and negative in skin involvement by WM&#41; and of <span class="elsevierStyleItalic">MYD88</span> gene mutation &#40;somatic mutation L265P is present in the majority of cases of WM<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#41; and t11&#59;18 translocation &#40;present in MZL&#41; can be used to make a definitive diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In multiple myeloma&#44; the lesions analogous to the neoplastic lesions of WM are plasmacytomas&#46; These present clinically as erythematous-violaceous or erythematous-yellowish plaques or nodules&#44; and are the result of direct infiltration of the skin from underlying bony foci&#46; Histology reveals a deep dermal and hypodermal infiltrate of plasma cells that are positive for CD38 and CD138 and negative for B-cell markers&#46; In contrast to lesions due to infiltration by WM&#44; the presence of plasmacytomas worsens the prognosis of multiple myeloma&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We draw attention to the peculiarities of our case because direct cutaneous infiltration by the lymphoproliferative disease is relatively rare&#44; based on the literature&#44; and does not lead to a worsening of the prognosis despite being a manifestation of disease progression&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Oscoz-Jaime S&#44; Agull&#243;-P&#233;rez AD&#44; Llanos-Chavarri C&#44; Yanguas-Bayona JI&#46; Infiltraci&#243;n cut&#225;nea por macroglobulinemia de Waldenstr&#246;m&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;75&#8211;78&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Initial presentation&#58; desquamating erythematous plaques on the chest and flanks&#46; B&#44; Healing of the skin lesions a month after completing chemotherapy treatment&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Perivascular lymphoplasmacytic infiltrates around the superficial and deep plexuses&#46; Hematoxylin and eosin &#40;H&#38;E&#41;&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; B&#44; Periglandular lymphoplasmacytic infiltrates&#46; H&#38;E&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40&#46; C&#44; Positivity for CD20 in the lymphoplasmacytic infiltrate&#46; CD20 immunohistochemical stain&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&#46; D&#44; Negativity for CD38 in the neoplastic infiltrate&#46; The few plasma cells that are present are not monoclonal cells and are positive for CD38&#46; CD38 immunohistochemical stain&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CHOP&#44; cyclophosphamide<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>doxorubicin<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vincristine<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisone&#59; F&#44; female&#59; M&#44; male&#59; NP&#44; not performed&#59; NR&#44; not recorded or not performed&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">No&#46; of Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Mean Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sex&#44; M&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Cutaneous Manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Cutaneous Histology<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Bone Marrow<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">L265P Mutation in Gene <span class="elsevierStyleItalic">MYD88</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sites of desquamating erythematous-violaceous plaques&#58;<br>Face and auricles of the ears&#58; 13&#47;20<br>Trunk&#58; 7&#47;20<br>Lower limbs&#58; 4&#47;20<br>Upper limbs&#58; 2&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphoplasmacytic infiltrate in the reticular dermis and hypodermis&#46;<br><br>IgM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#58; 12&#47;20<br>IgM&#8211; or NP&#58; 8&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&#58; 15&#47;20<br>Negative or NR&#58; 5&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clorambucil&#58; 9&#47;20<br>Cyclophosphamide&#58; 3&#47;20<br>Vincristine&#58; 3&#47;20<br>Radiotherapy&#58; 2&#47;20<br>CHOP&#58; 2&#47;20<br>Lomustine&#58; 1&#47;20<br>Plasmapheresis&#58; 1&#47;20<br>Rituximab<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>bendamustine&#58; 1&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NR&#58; 19&#47;20<br>Positive&#58; 1&#47;20 &#40;Oscoz-Jaime et al&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Bone marrow biopsy&#58; Positive indicates consistent with lymphoplasmacytic lymphoma&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of Cases of Skin Involvement by Waldenstr&#246;m Macroglobulinemia Reported in the Literature &#40;See Additional Material&#41;&#46;</p>"
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Case and Research Letters
Cutaneous Infiltration due to Waldenström Macroglobulinemia
Infiltración cutánea por macroglobulinemia de Waldenström
S. Oscoz-Jaimea,
Autor para correspondencia
saioaoscoz@gmail.com

Corresponding author.
, A.D. Agulló-Péreza, C. Llanos-Chavarrib, J.I. Yanguas-Bayonaa
a Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona (Navarra), Spain
b Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona (Navarra), Spain
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Study of the L265P mutation in exon 5 of gene <span class="elsevierStyleItalic">MYD88</span> &#40;3p22&#46;2&#41; was positive&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The metastatic work-up showed axillary&#44; retroperitoneal&#44; iliac&#44; and inguinal lymphadenopathies and hepatosplenomegaly&#46; The patient did not report symptoms suggestive of hyperviscosity&#44; and adipose tissue biopsy was negative for amyloid&#46; It was therefore decided to adopt a wait-and-see approach&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In September 2014&#44; the patient was seen in dermatology for the appearance of asymptomatic erythematous plaques with mild desquamation on his upper trunk&#44; back&#44; and face &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Histology revealed a lymphoplasmacytic infiltrate suggestive of B-cell lymphoma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; A and B&#41;&#44; predominantly positive for CD20 &#40;with a 2&#58;1 ratio with CD3&#41; and negative for CD38 and CD138 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; C and D&#41;&#46; The few associated plasma cells did not show &#955;&#47;&#954; light chain restriction&#46; Genetic analysis identified positive monoclonal IgH &#40;FR1 region&#41; and biclonal IgH &#40;FR3 region&#41; rearrangements&#44; confirming the diagnosis as cutaneous infiltration by lymphoplasmacytic lymphoma&#47;WM&#46; Immunohistochemistry for IgM was not performed on the skin biopsy because that study is not available at our hospital&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical progression &#40;asthenia&#44; joint pain&#44; weight loss&#44; sweating&#41; was observed during 2015&#44; with progressive anemia &#40;hemoglobin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and an increase in the size of the previously present lymph nodes&#46; It was therefore decided to start systemic treatment with 6 cycles of rituximab plus bendamustine at standard doses&#46; In addition&#44; topical methylprednisolone was prescribed for the skin lesions&#46; A month after completing the chemotherapy regimen&#44; the skin lesions had disappeared&#46; The patient reported an improvement in his general wellbeing&#44; and blood test results &#40;hemoglobin &#62;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and radiological findings had improved&#46; At the time of writing&#44; the patient has no general or cutaneous symptoms and continues on follow-up by the hematology department &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">WM is a rare B-cell lymphoproliferative disorder of unknown etiology&#46; It is characterized by a proliferation of lymphoplasmacytic cells in the bone marrow and a monoclonal IgM peak in peripheral blood&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Skin involvement occurs in 5&#37; of patients with WM&#46; According to the classification by Libow et al&#46;&#44; 2<span class="elsevierStyleHsp" style=""></span>types of skin lesion can develop<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a>&#58; neoplastic lesions due to direct infiltration of the skin by the lymphoplasmacytic cells&#59; and nonneoplastic lesions&#44; secondary to the paraproteinemia&#46; The nonneoplastic lesions are more common and are divided into 3 subtypes&#58; those caused by a hyperviscosity syndrome &#40;acral purpura&#44; mucosal bleeding&#44; peripheral edema&#41;&#59; those associated with cryoglobulinemia &#40;acral cyanosis&#44; Raynaud phenomenon&#44; cold hypersensitivity&#44; livedo reticularis&#44; leukocytoclastic vasculitis&#41;&#59; and those related to the specific paraproteins &#40;IgM bullous dermatosis&#44; macroglobulinemia cutis&#44; and erythematous papules associated with WM&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The neoplastic skin lesions&#44; due to direct infiltration of the skin by the lymphoplasmacytic cells&#44; are less common&#46; Only around 20 cases have been reported in the literature&#44; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;8</span></a> and their diagnosis in daily practice is very rare&#46; They present clinically as mildly desquamating&#44; slightly infiltrated erythematous plaques localized mainly symmetrically on the face and ears and also on the chest&#44; flanks&#44; and back&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;8</span></a> They can arise early in the course of the disease&#44; but it should be stressed that their presence does not worsen the prognosis&#46; Cells found in these skin lesions are from the lymphoplasmacytic cell line&#46; They are positive for B-cell markers &#40;CD19&#44; CD20&#44; CD22&#41; and negative for plasma cell markers &#40;CD38 and CD138&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The distinction between cases of lymphoplasmacytic lymphoma&#47;WM and marginal zone lymphoma &#40;MZL&#41; with intense plasmacytic differentiation can be difficult in some cases because of the degree of clinical-pathologic overlap&#46; Investigation of cyclin D1 &#40;positive in MZL and negative in skin involvement by WM&#41; and of <span class="elsevierStyleItalic">MYD88</span> gene mutation &#40;somatic mutation L265P is present in the majority of cases of WM<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#41; and t11&#59;18 translocation &#40;present in MZL&#41; can be used to make a definitive diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In multiple myeloma&#44; the lesions analogous to the neoplastic lesions of WM are plasmacytomas&#46; These present clinically as erythematous-violaceous or erythematous-yellowish plaques or nodules&#44; and are the result of direct infiltration of the skin from underlying bony foci&#46; Histology reveals a deep dermal and hypodermal infiltrate of plasma cells that are positive for CD38 and CD138 and negative for B-cell markers&#46; In contrast to lesions due to infiltration by WM&#44; the presence of plasmacytomas worsens the prognosis of multiple myeloma&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We draw attention to the peculiarities of our case because direct cutaneous infiltration by the lymphoproliferative disease is relatively rare&#44; based on the literature&#44; and does not lead to a worsening of the prognosis despite being a manifestation of disease progression&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Oscoz-Jaime S&#44; Agull&#243;-P&#233;rez AD&#44; Llanos-Chavarri C&#44; Yanguas-Bayona JI&#46; Infiltraci&#243;n cut&#225;nea por macroglobulinemia de Waldenstr&#246;m&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;75&#8211;78&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Initial presentation&#58; desquamating erythematous plaques on the chest and flanks&#46; B&#44; Healing of the skin lesions a month after completing chemotherapy treatment&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Perivascular lymphoplasmacytic infiltrates around the superficial and deep plexuses&#46; Hematoxylin and eosin &#40;H&#38;E&#41;&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; B&#44; Periglandular lymphoplasmacytic infiltrates&#46; H&#38;E&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40&#46; C&#44; Positivity for CD20 in the lymphoplasmacytic infiltrate&#46; CD20 immunohistochemical stain&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&#46; D&#44; Negativity for CD38 in the neoplastic infiltrate&#46; The few plasma cells that are present are not monoclonal cells and are positive for CD38&#46; CD38 immunohistochemical stain&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CHOP&#44; cyclophosphamide<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>doxorubicin<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vincristine<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisone&#59; F&#44; female&#59; M&#44; male&#59; NP&#44; not performed&#59; NR&#44; not recorded or not performed&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">No&#46; of Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Mean Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sex&#44; M&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Cutaneous Manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Cutaneous Histology<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Bone Marrow<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">L265P Mutation in Gene <span class="elsevierStyleItalic">MYD88</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sites of desquamating erythematous-violaceous plaques&#58;<br>Face and auricles of the ears&#58; 13&#47;20<br>Trunk&#58; 7&#47;20<br>Lower limbs&#58; 4&#47;20<br>Upper limbs&#58; 2&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphoplasmacytic infiltrate in the reticular dermis and hypodermis&#46;<br><br>IgM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#58; 12&#47;20<br>IgM&#8211; or NP&#58; 8&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&#58; 15&#47;20<br>Negative or NR&#58; 5&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clorambucil&#58; 9&#47;20<br>Cyclophosphamide&#58; 3&#47;20<br>Vincristine&#58; 3&#47;20<br>Radiotherapy&#58; 2&#47;20<br>CHOP&#58; 2&#47;20<br>Lomustine&#58; 1&#47;20<br>Plasmapheresis&#58; 1&#47;20<br>Rituximab<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>bendamustine&#58; 1&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NR&#58; 19&#47;20<br>Positive&#58; 1&#47;20 &#40;Oscoz-Jaime et al&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Bone marrow biopsy&#58; Positive indicates consistent with lymphoplasmacytic lymphoma&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of Cases of Skin Involvement by Waldenstr&#246;m Macroglobulinemia Reported in the Literature &#40;See Additional Material&#41;&#46;</p>"
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    "bibliografia" => array:2 [
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ISSN: 15782190
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