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Oct 2011

Subcutaneous Nodules in an Elderly Patient —Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(10):1215-1220. doi:10.1001/archdermatol.2011.285-a

A 73-year-old Asian woman, recently diagnosed as having lung adenocarcinoma and monoclonal gammopathy, presented with 3 firm subcutaneous nodules of 2 years' duration on the right arm, central chest, and left hip. The nodules were asymptomatic but had enlarged and developed a reddish-yellow appearance over the prior 3 months. A staging positron emission tomographic –computed tomographic scan for lung adenocarcinomahighlighted the skin lesions; fine needle aspiration performed to rule out cutaneous metastases showed fat necrosis. Physical examination revealed a thin, healthy-appearing elderly woman with 1-cm firm, moveable nodules with overlying erythema on the right arm and central chest, and a 3-cm oval erythematous plaque with a xanthomatous hue on the left hip (Figure 1). She denied recent weight loss, fever, bone pain, or fatigue. Findings from laboratory studies showed a normal blood cell count, increased serum viscosity, and elevated β-microglobulin level; serum protein electrophoresis revealed a monoclonal IgG κ spike. A biopsy of the left hip lesion was performed (Figure 2 and Figure 3).

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