Dermatology and Venereology Department, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
Dermatology and Venereology Department, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco.
BMJ Case Rep. 2023 Jan 31;16(1):e250782. doi: 10.1136/bcr-2022-250782.
A woman in her 50s presented with total scarring ulcerated alopecia evolving for 10 years, and a recent budding tumour on the lower lip. Clinical examination revealed an associated exfoliated and infiltrated erythroderma with ulcerated cutaneous tumours of the legs, palmoplantar hyperkeratosis, hepatosplenomegaly and diffuse lymphadenopathies.Dermatoscopy of the scalp, leg tumours and infiltrated skin showed a typical yellowish background overlaid by arborescent vessels and whitish areas. Cutaneous biopsies of the same areas found sarcoidotic granulomas. Lip biopsy found an associated well-differentiated squamous cell carcinoma. Investigations confirmed the diagnosis of systemic sarcoidosis with an elevated converting enzyme level, mediastinal calcified lymphadenopathies in CT scan and deep localisations in positron emission tomography scan (thyroid, lymph nodes, mediastinum, liver, spleen and adrenal glands).The patient was treated with oral prednisone for sarcoidosis and intramuscular bleomycin followed by surgery and radiotherapy for squamous cell carcinoma. Sarcoidotic lesions healed, but a recurrence of her carcinoma led to death.
一位 50 多岁的女性患者出现了 10 年的全瘢痕性溃疡性脱发，近期下唇出现了一个新的萌芽状肿瘤。临床检查发现，患者下肢存在红斑、脱屑和浸润性红色斑块，伴有溃疡性皮肤肿瘤，手掌和足底过度角化，肝脾肿大和弥漫性淋巴结病。头皮、腿部肿瘤和浸润性皮肤的皮肤镜检查显示，典型的黄色背景上覆盖着树枝状血管和白色区域。同一区域的皮肤活检发现类肉瘤性肉芽肿。唇部活检发现相关的分化良好的鳞状细胞癌。检查结果证实了系统性类肉瘤病的诊断，其转化酶水平升高，CT 扫描显示纵隔钙化淋巴结病，正电子发射断层扫描（甲状腺、淋巴结、纵隔、肝脏、脾脏和肾上腺）显示深部定位。该患者接受了口服泼尼松龙治疗类肉瘤病和肌肉内博来霉素，随后进行了手术和放疗治疗鳞状细胞癌。类肉瘤病变愈合，但癌症复发导致患者死亡。
