Painful Erythematous Plaques on the Trunk | Dermatology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Painful Erythematous Plaques on the Trunk

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A woman in her 40s presented with painful erythematous plaques on her trunk (Figure, A). Skin lesions developed 2 months earlier and progressively spread. She reported abdominal discomfort, weight loss, and vaginal bleeding. A solid mass on her lower abdomen that had been palpable about 10 years prior had rapidly increased in size within the past few months. Physical examination revealed erythematous plaques on the right chest and flank without warmth. Punch biopsy of a lesion from the chest was sent for histopathological examination (Figure, B and C).

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

C. Metastatic carcinoma

Results of histopathological examination showed atypical cells with intracytoplasmic vacuoles forming a glandular architecture in the deep dermis, and lymphovascular invasion was observed (Figure, B and C). Immunohistochemical staining results were positive for CK7 and negative for CK20, estrogen receptors (ERs), GATA-binding protein 3, gross cystic disease fluid protein 15, Wilms tumor 1 (WT1), and thyroid transcription factor-1. Findings from chest and abdominopelvic computed tomography revealed a 13-cm heterogeneously enhancing mass in the right rectus abdominis muscle and a 3-cm ovarian cystic lesion (Figure, D). Positron emission tomography/computed tomography findings revealed intense abnormal 18F-fluorodeoxyglucose uptake in the abdominal wall, lung, liver, and lymph nodes. Laboratory examinations revealed increased concentrations of lactate dehydrogenase (558 U/L; reference, 135-214 U/L; to convert to μkat/L, multiply by 0.0167), cancer antigen 15-3 (143.8 U/mL; reference, <26.4 U/mL; to convert to kU/L, multiply by 1.0), and cancer antigen 125 (2528 U/mL; reference, <35 U/mL; to convert to kU/L, multiply by 1.0), and a normal carcinoembryonic antigen level (2.2 ng/mL; reference, <6 ng/mL; to convert to μg/L, multiply by 1.0). The patient underwent debulking surgery, and pathologic examination revealed poorly differentiated carcinoma positive for MOC31, napsin A, and PAX8, and negative for calretinin, WT1, CK5/6, ERs, gross cystic disease fluid protein 15, and p53. The patient was diagnosed with primary peritoneal clear cell carcinoma (PPCCC) with multiple distant metastases. She underwent chemotherapy with paclitaxel and carboplatin, but the disease progressed continuously. Another metastatic lesion developed in her abdomen. Despite treatment with topotecan and cisplatin, she died 6 months after the initial diagnosis.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

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

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Mira Choi, MD, PhD, Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea (mirachoi0810@gmail.com).

Published Online: May 11, 2022. doi:10.1001/jamadermatol.2022.1371

Conflict of Interest Disclosures: Dr Park reported grants from AbbVie, Janssen, Novartis, and Lilly outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient’s husband for granting permission to publish this information.

References
1.
Agarwal  D , Jaiswal  M .  Primary peritoneal clear cell carcinoma—a diagnostic dilemma.   Indian J Case Rep. 2020;3(4):208-210. doi:10.32677/IJCR.2017.v03.i04.014 Google ScholarCrossref
2.
Wong  HK , Kaffenberger  BH , Zirwas  M .  A palpable erythematous cord over the trunk in a patient with systemic lupus erythematosus: interstitial granulomatous dermatitis (IGD).   JAMA Dermatol. 2013;149(5):609-614. doi:10.1001/jamadermatol.2013.2647a PubMedGoogle ScholarCrossref
3.
Peroni  A , Colato  C , Schena  D , Gisondi  P , Girolomoni  G .  Interstitial granulomatous dermatitis: a distinct entity with characteristic histological and clinical pattern.   Br J Dermatol. 2012;166(4):775-783. doi:10.1111/j.1365-2133.2011.10727.x PubMedGoogle ScholarCrossref
4.
Mahajan  R , De  D , Saikia  UN .  Wolf’s isotopic response: report of a case and review of literature.   Indian J Dermatol. 2014;59(3):275-282. doi:10.4103/0019-5154.131401 PubMedGoogle ScholarCrossref
5.
Ruocco  V , Ruocco  E , Brunetti  G , Russo  T , Gambardella  A , Wolf  R .  Wolf’s post-herpetic isotopic response: infections, tumors, and immune disorders arising on the site of healed herpetic infection.   Clin Dermatol. 2014;32(5):561-568. doi:10.1016/j.clindermatol.2014.04.003 PubMedGoogle ScholarCrossref
6.
Alnafisah  F , Dawa  SK , Alalfy  S .  Skin endometriosis at the caesarean section scar: a case report and review of the literature.   Cureus. 2018;10(1):e2063. doi:10.7759/cureus.2063 PubMedGoogle ScholarCrossref
7.
Sun  JY , Gebre  W , Dong  YM , Shaun  X , Robbins  R , Podrumar  A .  Primary peritoneal carcinoma metastasizing to breast: a single case report and literature review from clinic to biology.   Cancer Biol Med. 2016;13(3):389-395. doi:10.20892/j.issn.2095-3941.2016.0058 PubMedGoogle ScholarCrossref
8.
Kim  YM , Lee  YM , Lee  SH , Lee  DW , Kim  KH .  Primary peritoneal carcinoma initially presenting as atypical cervical lymphadenopathy.   Case Rep Oncol. 2015;8(2):246-250. doi:10.1159/000431253 PubMedGoogle ScholarCrossref
9.
Thomakos  N , Diakosavvas  M , Machairiotis  N , Fasoulakis  Z , Zarogoulidis  P , Rodolakis  A .  Rare distant metastatic disease of ovarian and peritoneal carcinomatosis: a review of the literature.   Cancers (Basel). 2019;11(8):1044. doi:10.3390/cancers11081044 PubMedGoogle ScholarCrossref
10.
Shigeta  N , Yoshino  K , Matsuzaki  S , Morii  E , Ueda  Y , Kimura  T .  Clear cell adenocarcinoma of the peritoneum: a case report and literature review.   J Ovarian Res. 2014;7:86. doi:10.1186/s13048-014-0086-2PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close