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Hoffmann E, Böke S, De-Colle C, Lengerke C, Niyazi KM, Gani C. Ulcerating skin lesions from blastic plasmacytoid dendritic cell neoplasm responding to low-dose radiotherapy-a case report and literature review. Strahlenther Onkol 2024:10.1007/s00066-024-02200-2. [PMID: 38285172 DOI: 10.1007/s00066-024-02200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that can manifest with skin nodules and erythematous plaques. In most cases BPDCN progresses rapidly, causing multiple skin lesions and also affecting internal organs and bone marrow, warranting initiation of systemic therapies or hematopoietic stem cell transplantation (HCT). Although not curative, radiotherapy for isolated lesions might be indicated in case of (imminent) ulceration and large or symptomatic lesions. To this end, doses of 27.0-51.0 Gy have been reported. Here, we present the case of an 80-year-old male with BPDCN with multiple large, nodular, and ulcerating lesions of the thorax, abdomen, and face. Low-dose radiotherapy of 2 × 4.0 Gy was administered to several lesions, which resolved completely within 1 week with only light residual hyperpigmentation of the skin in affected areas and reliably prevented further ulceration. Radiotoxicity was not reported. Therefore, low-dose radiotherapy can be an effective and low-key treatment in selected cases of BPDCN, especially in a palliative setting, with a favorable toxicity profile.
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Affiliation(s)
- Elgin Hoffmann
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany.
| | - Simon Böke
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Chiara De-Colle
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Claudia Lengerke
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Karim-Maximilian Niyazi
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Cihan Gani
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
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Lee HJ, Park HM, Ki SY, Choi YD, Yun SJ, Lim HS. Blastic plasmacytoid dendritic cell neoplasm of the breast: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e25699. [PMID: 34106594 PMCID: PMC8133119 DOI: 10.1097/md.0000000000025699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma. PATIENT CONCERNS We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque. DIAGNOSES Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN. INTERVENTIONS The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation. OUTCOMES The patient remains in complete remission state without relapse at 34 months since initial diagnosis. LESSONS This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.
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Affiliation(s)
| | | | | | | | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Republic of Korea
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Ding Y, Yang J, Lindsey K. Cytologic features of blastic plasmacytoid dendritic cell neoplasm involving liver: A case report and literature review. Diagn Cytopathol 2020; 49:E80-E83. [PMID: 32852895 DOI: 10.1002/dc.24594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/07/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare but clinically aggressive hematologic malignancy, believed to originate from plasmacytoid dendritic cells (PDCs) although it possesses multilineage potentials. Due to the dismal prognosis, accurate and rapid diagnosis is critical for early management. The disease usually initially involves skin and bone marrow. Here we report the cytopathologic findings in a case of BPDCN involving the liver in a patient previously diagnosed with BPDCN from skin and lymph node biopsies. The fine-needle aspiration specimen from the liver lesion demonstrates a hypercellular smear of atypical epithelioid cells dispersed singly or in loose groups. These cells have enlarged, eccentric, round to irregular nuclei with fine chromatin. The agranular gray-blue cytoplasm shows delicate wispy cytoplasmic extensions and cytoplasmic microvacuoles. Binucleation is common. The concurrent core biopsy shows that the neoplastic plasmacytoid cells with eccentric nuclei were positive for CD4, CD7, CD43, CD56, and CD68, confirming the diagnosis of BPDCN. Mutations of ASXL1 and TET2, classic for BPDCN, and a complex karyotype were detected in skin, bone marrow, and lymph node specimens. We catalog the heterogeneous pathologic features of this rare disease, emphasizing the clinical and histopathological correlation. The differential diagnoses and review of literature are also included. Awareness of this disease and accurate diagnosis are emphasized to aid early management and potentially produce a better clinical outcome.
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Affiliation(s)
- Yanna Ding
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Yang
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn Lindsey
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
BPDCN is ultimately a bone marrow disease requiring induction-type eradication therapy followed by hematopoietic stem cell transplant (HSCT) to achieve long-lasting remissions or cure. Various regimens have been applied to this disease with varying success. A cumulative review of the literature suggests more intense regimens have greater efficacy with acute lymphoblastic leukemia regimens preferred to acute myeloid leukemia regimens. This approach benefits fit patients who are eligible for HSCT; however, most BPDCN patients require other treatment options. The recent FDA approval of the CD123-targeted agent tagraxofusp provides a novel therapeutic alternative to traditional chemotherapy but with potential toxicities.
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Diallo YL, Cucherousset J, Samassekou O, Doumbere M, Cissoko Y, Menta DT, Ouologuem N, Ouologuem M, Konate M, Sidibe AT. Blastic plasmacytoid dendritic cell leukemia in a black malian. Niger J Clin Pract 2017; 20:777-781. [PMID: 28656936 DOI: 10.4103/1119-3077.208955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy, that most commonly manifests as cutaneous lesions. A 19-year-old Malian female was admitted to the Unit of Medicine of Hopital du Mali with anemia, fever, weakness, and weight loss. On physical examination she was wasted, pale, febrile (37.4°C), and had inguinal and axillary lymphadenopathies. The complete blood count found pancytopenia with Hemoglobin level of 4.8 g/dL, Leucocytes count of 1900/μL (neutrophil: 300/μL), and platelets count of 56 000/μL. The ultrasonographic examination found hepatomegaly and splenomegaly. The bone marrow biopsy and flow cytometer analysis were in keeping with a diagnosis of BPDCN. The patient, unfortunately, was lost four months later after her hospital admission due to late diagnosis by septicemia. The early diagnosis and availability of specific drugs for acute leukemia could improve the clinical outcome of patients with BPDCN in Mali.
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Affiliation(s)
- Y L Diallo
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - J Cucherousset
- Service de Pathologie, GHI Le RAINCY-MONTFERMEIL, France
| | - O Samassekou
- Institut National de Recherche en Santé Publique, Mali
| | - M Doumbere
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - Y Cissoko
- Service de Médicine Hôpital de GAO, Sossokoira Gao, Mali
| | - D T Menta
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - N Ouologuem
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - M Ouologuem
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - M Konate
- Service de Médecine Hôpital du Mali, Bamako, Mali
| | - A T Sidibe
- Service de Médecine Hôpital du Mali, Bamako, Mali
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Atypical myeloid neoplasm posing a diagnostic challenge between BPDCN and AML: a case report and review of literature. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Garcia-Recio M, Martinez-Serra J, Bento L, Ramos R, Gines J, Daumal J, Sampol A, Gutierrez A. Lenalidomide, celecoxib, and azacitidine therapy for blastic plasmocytoid dendritic cell neoplasm: a case report. Onco Targets Ther 2016; 9:5507-11. [PMID: 27660468 PMCID: PMC5019433 DOI: 10.2147/ott.s107893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Blastic plasmocytoid dendritic cell neoplasm is characterized by aggressive behavior with a tendency for systemic dissemination and a predilection for skin, lymph nodes, soft tissues, peripheral blood, or bone marrow. It usually occurs in elderly patients with a mean age between 60 and 70 years. Despite initial response to chemotherapy, the disease regularly relapses with a short median overall survival. Better outcomes have been reported with high-dose acute leukemia-like induction chemotherapy followed by consolidation with allogeneic hematopoietic stem cell transplantation. However, elderly patients are not candidates for intensive therapy or allogeneic stem cell transplantation. So, new active and tolerable drugs are needed. Our case illustrates that one cycle of lenalidomide and celecoxib provides at least a partial cutaneous and hematologic response, but this regimen was discontinued due to toxicity and followed by a consolidation/maintenance phase with azacitidine, thus achieving a final complete response with a much higher than expected progression-free and overall survival in an elderly patient with comorbidities. This information may be useful in the design of treatment approaches for elderly patients with blastic plasmocytoid dendritic cell neoplasm. However, it should be confirmed in clinical trials as well as by optimizing the induction and extending the consolidation/maintenance period to avoid early relapses after discontinuation and improve progression-free survival.
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Affiliation(s)
- Marta Garcia-Recio
- Service of Hematology; Instituto de Investigación Sanitaria de Palma (IdISPa)
| | | | - Leyre Bento
- Service of Hematology; Instituto de Investigación Sanitaria de Palma (IdISPa)
| | - Rafael Ramos
- Instituto de Investigación Sanitaria de Palma (IdISPa); Service of Pathology
| | | | - Jaime Daumal
- Service of Nuclear Medicine, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Antonia Sampol
- Service of Hematology; Instituto de Investigación Sanitaria de Palma (IdISPa)
| | - Antonio Gutierrez
- Service of Hematology; Instituto de Investigación Sanitaria de Palma (IdISPa)
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Shimomura M, Asano T, Furue A, Miki M, Sera Y, Kawaguchi H, Nakamura K, Kobayashi M. Effective Treatment of a Childhood Blastic Plasmacytoid Dendritic Cell Neoplasm with a Cutaneous Tumor Alone by Stem Cell Transplantation with Reduced Intensity Conditioning. Indian J Hematol Blood Transfus 2016; 32:26-31. [PMID: 27408349 DOI: 10.1007/s12288-015-0543-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/13/2015] [Indexed: 11/29/2022] Open
Abstract
Pediatric blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy that has an extremely poor prognosis despite the use of intensive chemotherapy. Recently, treatment of BPDCN with bone marrow transplantation (BMT) using myeloablative conditioning has been reported to increase survival in adults. We report a 9-year-old girl with cutaneous BPDCN who was successfully treated with combination chemotherapy followed by BMT using reduced intensity conditioning (RIC), without any adverse complications. The success of this treatment regimen suggests that BMT with RIC may be a feasible option for treating children with cutaneous BPDCN.
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Affiliation(s)
- Maiko Shimomura
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan ; Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505 Japan
| | - Takaki Asano
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Aya Furue
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Mizuka Miki
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Yasuhiko Sera
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Hiroshi Kawaguchi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Kazuhiro Nakamura
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Masao Kobayashi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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Wang F, Xu L. [Diagnostic and therapeutic advances in blastic plasmacytoid dendritic cell neoplasm]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:75-8. [PMID: 26876261 PMCID: PMC7342307 DOI: 10.3760/cma.j.issn.0253-2727.2016.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang YY, Liu YR, Li K, Li K, Liu SH. A woman with rare blastic plasmacytoid dendritic cell neoplasm on the face. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e16-8. [DOI: 10.1016/j.oooo.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/03/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
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Kim JH, Park HY, Lee JH, Lee DY, Lee JH, Yang JM. Blastic Plasmacytoid Dendritic Cell Neoplasm: Analysis of Clinicopathological Feature and Treatment Outcome of Seven Cases. Ann Dermatol 2015; 27:727-37. [PMID: 26719643 PMCID: PMC4695426 DOI: 10.5021/ad.2015.27.6.727] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN), which is derived from the precursor of plasmacytoid dendritic cells, is a rare and highly aggressive hematologic malignancy. It has only recently been recognized as a distinct entity. BPDCN characteristically has a predilection for cutaneous involvement. OBJECTIVE The aim of this study was to describe the clinical and pathological features of BPDCN, and to review the treatment courses to analyze the prognosis and the optimal therapeutic approach. METHODS We retrospectively reviewed seven BPDCN cases registered in the Samsung Medical Center database between January 2010 and December 2014. RESULTS The median age of the patients was 52 years (range, 18~79 years), and six patients were male. The clinical staging was as follows: skin (n=5), lymph node (n=6), bone marrow (n=4), and peripheral blood (n=2). The skin manifestations were bruise-like tumefaction (n=4), erythematous nodule (n=4), or multiple erythematous papules (n=1). The pathological evaluation revealed dense diffuse or nodular infiltration of neoplastic cells, which were positive for CD4, CD56, and CD123 in the immunohistochemical analysis. Six patients received multiagent chemotherapy as the first-line treatment, alone (n=4), or followed by stem cell transplantation (SCT, n=1) or concurrent radiotherapy (n=1). The median progression-free survival after the first-line treatment was 6 months (range, 2~12 months). CONCLUSION Three different skin manifestations were observed, with pathological features analogous to each other. All patients who received chemotherapy without SCT achieved partial or complete response but experienced relapse. Furthermore, they showed various clinical courses irrelevant to the cutaneous involvement.
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Affiliation(s)
- Jun-Hwan Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Young Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Mo Yang
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liegeon AL, Fougerousse AC, Carassou P, Valois A, Veran Y. Manifestations cutanées révélatrices d’une leucémie aiguë dendritique plasmocytoïde (LADP) : deux observations. Presse Med 2015; 44:681-4. [DOI: 10.1016/j.lpm.2015.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/11/2015] [Accepted: 01/27/2015] [Indexed: 12/01/2022] Open
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Chou YH, Lin RY, Lee MS, Wu HP, Lin CP, Wu CY. Bruise-like cutaneous lesions as the early presentation of blastic plasmacytoid dendritic cell neoplasm. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Laribi K, Denizon N, Ghnaya H, Atlassi M, Besançon A, Pineau-Vincent F, Gaulard P, Petrella T. Blastic plasmacytoid dendritic cell neoplasm: the first report of two cases treated by 5-Azacytidine. Eur J Haematol 2014; 93:81-5. [DOI: 10.1111/ejh.12294] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Kamel Laribi
- Hematology Department; Centre Hospitalier Le Mans; Le Mans France
| | - Nathalie Denizon
- Hematology Department; Centre Hospitalier Le Mans; Le Mans France
| | - Habib Ghnaya
- Hematology Department; Centre Hospitalier Le Mans; Le Mans France
| | - Mustapha Atlassi
- Hematology Department; Centre Hospitalier Le Mans; Le Mans France
| | - Anne Besançon
- Hematology Department; Centre Hospitalier Le Mans; Le Mans France
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Chapman LW, Hsiao JL, Lewis M, Chiu MW, Shellow WVR. Progressive violaceous nodules and plaques in an elderly man. Int J Dermatol 2013; 52:1165-7. [PMID: 23834652 DOI: 10.1111/ijd.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lance W Chapman
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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