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September 15, 2008

Cutaneous Tumors, Massive Lymphadenopathy, and Secondary Lymphedema in a 16-Year-Old Boy—Quiz Case

Author Affiliations
 

CARRIE ANN R.CUSACKMDSENAIT W.DYSONMDJACQUELINE M.JUNKINS-HOPKINSMDVINCENTLIUMDKARLA S.ROSENMANMD

Arch Dermatol. 2008;144(9):1217-1222. doi:10.1001/archderm.144.9.1217-d

A 16-year-old boy presented with massive swelling of his left leg that had progressed over the last year. He complained of tremendous leg pain, which was causing difficulty with ambulation. He denied fever, chills, or a history of infectious disease.

Physical examination revealed several dark brown to violaceous, dome-shaped, 0.5-cm papules and 1.5- to 2.0-cm nodules as well as verrucous intact and ulcerated 4.0- to 5.0-cm tumors on the left lower extremity (Figure 1). Extensive left leg edema and massive inguinal lymphadenopathy were also observed. Radiography and computed tomography demonstrated multiple lytic bone lesions of the femur, spine, hip, and skull. A 4-mm punch biopsy specimen was obtained from a dome-shaped papule (Figure 2 and Figure 3).

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