Want to take quizzes and track your credits?
A 67-year-old man presented with a rapidly enlarging scalp lesion (Figure 1A) first noticed 3 months earlier as a pimple. The lesion was itchy but without generalized pruritus. The patient reported a weight loss of 10 pounds over the preceding 3 months. In addition, he reported a longer history of vague, nonspecific, intermittent abdominal pain without nausea, vomiting, or fever starting about 3 years prior to presentation. Previous work-up had revealed minimal abdominal adenopathy, but the patient declined further workup. On examination, he had no other cutaneous lesions, but he did have cervical lymphadenopathy. All other physical findings were within normal limits. Laboratory findings were unremarkable, save for a mild normochromic normocytic anemia and a mildly elevated levels of lactate dehydrogenase. A biopsy specimen from the skin lesion is shown in Figure 1B.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
B. Follicular lymphoma
Scalp lesion, lymph node, and bone marrow biopsy demonstrated involvement by CD10-positive, low-grade B-cell non-Hodgkin lymphoma (NHL), consistent with follicular lymphoma. A positron emission tomography (PET) scan revealed extensive hypermetabolic activity in the scalp soft tissue (standardized uptake value [SUV], 7.0) (Figure 2) and in the cervical (SUV, 9.1), axillary, upper thoracic, and abdominal lymph nodes (SUV, 3.9) compatible with lymphoma with a FLIPI score (Follicular Lymphoma International Prognostic Index) of 5. The patient underwent 6 cycles of R-CHOP chemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) and achieved a complete response verified by PET scan after cycle 4.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Corresponding Author: Haythem Ali, MD, Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Hospital, 2799 W Grand Blvd, CFP-5, Detroit, MI 48202 (HALI1@hfhs.org).
Published Online: September 13, 2018. doi:10.1001/jamaoncol.2018.3685
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
You currently have no searches saved.