QUIZ SECTION
An Asymptomatic Plaque on the Chest: A Quiz
Alessandro PILERI 1,2 , Susanna GUNNELLA 2 , Vieri GRANDI 2 , Vincenza MAIO 3 and Nicola PIMPINELLI 2
1
Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, IT-40138, Bolog-
na, 2 Dermatology Section, and 3 Anatomic Pathology Unit, Department of Surgery and Translational Medicine, Division Dermatology, University
of Florence, Florence, Italy. E-mail: [email protected]
A 38-year-old woman presented with a 2-month history of
an asymptomatic erythematous plaque on the jugular notch
area (Fig. 1). Dermoscopy revealed erythema at the border
of the lesion, while milky-red areas and linear-irregular
vessels were seen in the inner part of the lesion. No radial
streaming, pseudopods, peppering, or atypical pigmented
structures were found. The lesion was surgically removed
and histology showed the presence of spindle cells, some
with atypical characteristics, randomly aligned and disper-
sed within an abundant fibrous tissue (Fig. 1b, c). Further-
more, an inflammatory infiltrate within the spindle-cell
proliferation was observed. The patient had had a stage IIB
bulky Hodgkin’s lymphoma (HL), and had been in com-
plete remission for 5 years after 6 courses of multi-agent
chemotherapy, followed by radiotherapy of the mediastinal
area. Six months previously, below the suspicious plaque,
the patient had had a hypertrophic scar on the site of the
peripherally inserted central catheter (Fig. 1, red arrow).
What is your diagnosis? See next page for answer.
Fig. 1. (a) Erythematous plaque on the jugular notch (black arrow) above a previously treated hypertrophic scar (red arrow). Inset: Dermoscopic
characteristics of the lesion (from the border to the inner part): erythematous border, milky-red areas with linear-irregular vessels. (b) The presence of
spindle cells, randomly aligned and dispersed within an abundant fibrous tissue, with a co-exist