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Off-Center Fold
March 2007

Persistent Violaceous Papules on the Ears—Diagnosis

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Arch Dermatol. 2007;143(3):417-422. doi:10.1001/archderm.143.3.417-f

Biopsy specimens revealed a primary cutaneous diffuse large B-cell lymphoma. A dense monomorphous infiltrate of mononuclear cells extended from the upper reticular to the deep dermis. Scattered among the mononuclear cells were larger atypical CD20+ B cells with hyperchromatic nuclei. Immunoperoxidase stains showed a smaller amount of reactive CD45RO+, CD3+, CD5+, and CD79a T cells. Stains were negative for CD30, CD43, and κ and λ immunoglobulin light chains and strongly positive for Bcl-2. Gene rearrangement studies were positive for a monoclonal B-cell population, and polymerase chain reaction analysis revealed an IgG heavy-chain rearrangement. The extent of involvement of the ears made radiation therapy and local excision impractical. Also, considering the expected good prognosis, intensive chemotherapy was inappropriate. The patient was treated with rituximab, a chimeric monoclonal anti-CD20 antibody, at a dosage of 375 mg/m2 per day for 4 consecutive weeks, resulting in complete resolution of her disease.

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