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November 15, 2010

Rapidly Enlarging Mass on the Leg Develops After Local Trauma—Quiz Case

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Arch Dermatol. 2010;146(11):1301-1306. doi:10.1001/archdermatol.2010.319-a

A 77-year-old woman with a history of stage III (Durie-Salmon) IgA λ light chain multiple myeloma (MM), in remission for 1 year after treatment with melphalan and prednisone and radiation therapy, presented with a rapidly enlarging, painful mass on the lower left leg of severalweeks' duration (Figure 1). A slip and fall injury to the skin of the affected area had preceded the initial development of the mass by approximately 3 weeks. She did not have extramedullary MM at any point in her disease previously. There were no other cutaneous masses elsewhere. Treatment with antibiotics resulted in no improvement. Ultrasonography revealed no abnormalities of the circulatory system, and plain film radiography of the lower leg revealed no bony abnormalities. A skin biopsy was obtained (Figure 2 and Figure 3).

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