Discoid lupus erythematosus with epithelial dysplasia: a case report (original) (raw)
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Squamous Cell Carcinoma Complicating Discoid Lupus Erythematosus
International Journal of Dermatology, 1987
A 45-year-oid Chinese woman with a 12-year history of discoid lupus erythematosus (DLE) presented to our hospital v^/ith two fungating tumors on her DLE lesions on both forearms. The tumors had started on each forearm as nodules that grew slowly over 6 months. There was no preceding history of trauma or ionizing radiation to the forearms. She was treated with topical steroids by her general practitioner earlier. Examination then showed DLE plaques on her forearms, dorsum of the hands, face, and legs. A fungating tumor (measuring 7 cm in diameter each) was present on DLE plaques on each forearm (Fig. 1}. Abnormal laboratory findings included raised ESR (70 mm/hr) and positive antinuclear antibody test (titer 1/20, homogenous nuclear pattern). Results of blood counts, direct Coomb's test, liver function and renal function tests, VDRL test, urinaiysis, and chest x-ray were normal. Wide excision of the tumors with a skin graft of normallooking skin taken from the covered parts of both thighs was done. Histology of the excised tumor showed well-differentiated squamous cell carcinoma with dense lymphocytic dermal infiltrate (Fig. 2). The skin surrounding the tumor showed characteristic lupus erythematosus changes with epidermal atrophy, vacuoiar basal cell degeneration, thickened basement membrane, periappendageal lymphohistiocytic infiltrates, and telangiectasia in the upper and mid-dermis (Eig. 3). Direct immunofluorescence studies were negative. Eight months after surgery, new DLE lesions developed on the grafted skin (Fig. 4), and a biopsy specimen showed similar changes of DLE. The patient was given oral chloroquine sulfate 450 mg daily, and the DLE lesions became less erythematous; some lesions healed with scarring and no new lesions appeared. Chloroquine was tapered over 2 years, and the patient remained fairly well with residual DLE plaques on her forearms.
IOSR Journals , 2019
DLE/CCLE is a benign disorder of skin most frequently involving the face, characterized by well defined red scaly plaques of variable sizes that heal with atrophy, scarring and pigmentary changes. The histology is characteristic. Squamous cell carcinoma can rarely arise within a longstanding DLE plaque in the skin particularly over scalp, ears , lips and nose. It presents as an enlarging warty growth or ulcer. We report a case of squamous cell carcinoma which developed on lesion of discoid lupus erythematosus within a short period of time.
Discoid lupus erythematosus lesions developed on lupus erythematosus profundus nodules
International journal of dermatology, 1995
We describe this case of LEP for its unusual way of presentation. It first appeared with a LEP pattern, followed by a typical DLE of the skin, overlying the nodules only. Moreover, our histologic findings showed the typical pattern of lymphocytic lobular panniculitis, with hyaline necrosis of fat, the lymphoid nodule, and even the lymphocytic nuclear "dust." The epidermal changes, with the liquefaction degeneration of the basal cell layer, a moderate follicular hyperkeratosis, and a perivascular and periappendeal lymphocytic infiltrate, were also observed in the abdominal lesion that developed last without clinically evident DLE.
Squamous Cell Skin Carcinoma in Systemic Lupus Erythematosus: Case Report and Literature Review
The case report of squamous cell skin carcinoma diagnosed in a patient with systemic lupus erythematosus 26 years after the onset of rheumatic disease is presented. The features of this case included the absence of skin manifestations of systemic lupus erythematosus, the occurrence of a tumor at the site of ulcers and trophic disorders on the leg, a long period from the ulcer occurrence to the diagnosis of skin cancer (despite multiple biopsies and consultations of various specialists), as well as the occurrence of a cytokine release syndrome, which directly led to the death of the patient after the first use of the immune checkpoint inhibitors. Possible causes of skin cancer in patients with systemic lupus erythematosus, as well as the features of the cytokine release syndrome after immunotherapy for oncological diseases, are discussed.
Discoid lupus erythematosus: a profile
Journal of the College of Physicians and Surgeons Pakistan Jcpsp, 2010
To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus erythematosus (DLE). Study Design: Case series. Place and Duration of Study: Methodology: Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesion's location, size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for frequencies and percentages. Results: There were 110 patients (38 males and 72 females), with ages between 18 and 62 years. Family history was positive in 3 patients. The plaque form was the most common clinical type seen in 68 (61.8%) patients, followed by tumid (n=20, 18.2%), panniculitis (n=10, 9.1%) and ulcerative (n=8,7.3%) types. Face was the most common site affected (n=60, 54.5%). Antinuclear antibody was present in 19 (17.3%) patients. Fatigue and joint pains were the commonest symptoms (n=52, 47%). Pigmentation and scarring were the usual outcome. Conclusion: DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring.
International Journal of Family & Community Medicine, 2018
We report on a 54-year-old woman with long-lasting discoid lupus erythematosus (DLE) who presented at our department with discoid rash, fever, moderate cervical lymphadenopathy, extreme fatigue. Before that time, her DLE symptoms had been controlled with NSAIDs, and low-dose prednisone. Three weeks before presentation, she experienced fevers ranging from 38.0 to 39.0 °C, but she had no specific symptoms that suggested local infection. Physical examination, multiple blood cultures, and other laboratory investigations were performed to make the point of the situation. Abnormal laboratory parameters in cell blood count together with creatinine alteration and the appearance of antibodies to double-stranded DNA were crucial to make a diagnosis of an active Systemic Lupus Erythematosus (SLE). Important elevations of triglycerides and lactate dehydrogenase (LDH) found in the analysis, oriented us to further examine the patient toward a hematological condition. The biopsy from the axillary lymphonodes showed high grade diffuse large B-cell (CD20+, Ki-67+, Bcl-2+) non-Hodgkin's lymphoma. Through this case report we present a rare event when DLE progresses to SLE associated to non-Hodgkin's lymphoma. In these cases it is important a differential diagnosis that should take into account the possibility of active SLE, infection, and malignancy.