Wollina Uwe, Hansel Gesina, Langner Dana, Koch André, Schönlebe Jacqueline, Tchernev Georgi
Department of Dermatology and Allergology, "Georg Schmorl", Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany.
Institute of Pathology, "Georg Schmorl", Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany.
Open Access Maced J Med Sci. 2017 Jul 19;5(4):476-479. doi: 10.3889/oamjms.2017.085. eCollection 2017 Jul 25.
The sudden development of facial plaques and nodules may be an alarming clinical sign for underlying malignancies. Nevertheless, a broad range of inflammatory and infectious diseases must be considered as well in the differential diagnosis.
We report on a 53-year-old male patient with a left-sided cheek infiltration with oozing but no lymphadenopathy. He had a medical history of head-and-neck cancer. The primary differential diagnosis was herpes zoster with secondary impetiginization or pyoderma facial. About eight weeks later, the patient presented with progressive formation of nodules and plaques on the face and isotretinoin was stopped. Skin biopsy suggested mycosis fungoid and an oral treatment with bexarotene was started. After limited response for another eight weeks, he returned later with massive facial swelling, nodules and impetiginization. Another skin biopsy was performed to exclude diagnostic error or investigate possible disease progression. Microscopic evaluation and multiplex-polymerase chain reaction confirmed the diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTL-NOS), stage Ia (T1 N0 M0). Imaging techniques excluded metastatic spread. By interdisciplinary tumour board, R-CHOP (rituximab, cyclophosphamide, hydroxyl-doxorubicin, vincristine, and prednisolone) was recommended and initiated by hemato-oncologists.
PLT-NOS confirmed in the present patient has a poor prognosis with a 5-year survival rate of less than 20%.
面部斑块和结节的突然出现可能是潜在恶性肿瘤的一个警示性临床体征。然而，在鉴别诊断中也必须考虑到广泛的炎症性和感染性疾病。
我们报告一例53岁男性患者，左侧脸颊有浸润且有渗液，但无淋巴结病。他有头颈癌病史。初步鉴别诊断为带状疱疹伴继发性脓疱病或面部脓皮病。大约八周后，患者面部结节和斑块逐渐形成，异维A酸停用。皮肤活检提示蕈样霉菌病，开始口服贝沙罗汀治疗。在又一个八周反应有限后，他后来因面部大量肿胀、结节和脓疱病再次就诊。再次进行皮肤活检以排除诊断错误或调查可能的疾病进展。显微镜评估和多重聚合酶链反应确诊为外周T细胞淋巴瘤，非特指型（PTL-NOS），Ia期（T1 N0 M0）。影像学检查排除了转移扩散。通过多学科肿瘤委员会，血液肿瘤学家建议并开始使用R-CHOP（利妥昔单抗、环磷酰胺、羟基柔红霉素、长春新碱和泼尼松龙）方案治疗。
本患者确诊的PTL-NOS预后较差，5年生存率低于20%。
