Journal of Clinical & Experimental Dermatology Research
Open Access
ISSN: 2155-9554
+44 1478 350008
ISSN: 2155-9554
+44 1478 350008
Kylie L Beem
Alexandra Hospital, Brisbane, Australia
Posters & Accepted Abstracts: J Clin Exp Dermatol Res
Presenting Complaint: A 69 year old Vietnamese male was referred to dermatology outpatient��?s clinic by his respiratory physician with an erythematous plaque to his right chest wall. He described the rash as pruritic but not painful. Background: The patient had been diagnosed with right-sided epithelioid mesothelioma several years previously. This was slowly progressing and not causing him many symptoms. He was trialled on chemotherapy but this was discontinued due to severe nausea and vomiting. He had a stable right-sided hydropneumothorax that was not for intervention. He also had a history of diabetes and hypertension and no known allergies. Examination: On exam the patient had a 10x15cm erythematous, thickened plaque over his right flank. Impression: Clinical appearance was consistent with a lichenified dermatitis. Investigations: A 4mm punch biopsy was performed to exclude angiosarcoma. Results: The biopsy revealed changes of lichen simplex chronicus. The dermis also contained numerous prominent angulated dilated lymphatic channels and mild per-vascular infiltrate including lymphocytes, histiocytes and plasma cells. The lymphatic channels in the deep dermis were filled with atypical epithelioid cells. These were strongly cytokeratin (MNF116) positive with weak nuclear and cytoplasmic calretinin positivity. Findings/ Significance: Given the patient��?s known history of mesothelioma the cells in the deep lymphaticswere consistent with lymphatic permeation by mesothelioma. There was secondary lymphangiectasia and lichen simplex chronicus. Recent CT chest/abdomen also revealed slight increase in thickness of right-sided pleural mesothelioma with involvement of the right diaphragm and extension through the chest wall with marginal increase in size ofmediastinal lymphadenopathy. Conclusion: Given cutaneous involvement of malignant mesothelioma the patient was for palliative radiotherapy to the right chest wall. He was advised to use topical diprosone ointment for symptomatic management and was discharged from dermatology clinic.
Email: kyilebeem@gmail.com