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Feb 2012

Progressive Sclerodermoid Skin Changes —Diagnosis

Arch Dermatol. 2012;148(2):247-252. doi:10.1001/archderm.148.2.247-g

Histopathologic examination of the specimen with hematoxylin-eosin –stained sections showed large, atypical, hyperchromatic cells filling the lumina of small blood vessels in the mid and deep reticular dermis. These neoplastic cells were strongly positive for CD20 and BCL-2 and highly proliferative (>95% of the cells expressed Ki67), confirming the diagnosis of intravascular large B-cell lymphoma.

Our patient was referred to a major regional cancer center and underwent systemic chemotherapy with 5 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab. Over the course of treatment, her skin softened, mobility increased, and pain subsided. She was ultimately declared “cancer free ” by imaging and random skin biopsy findings. The patient was alive, and her cancer was in remission at last follow-up, more than 6 months after clinical presentation.