Caso para diagnóstico

Abstract

CASE REPORT60 year-old male patient with asymptomatic nodules on the face, neck, chest and scrotum noted 3 months previously. Reported smoking, drinking and illicit drug use and complained of fatigue, heartburn and weight loss of 15kg over the 3-month period. Physical examination revealed erythematous-violaceous nodules on the scalp, face, neck, chest, upper limbs and scrotum. The nodules, some of them exulcerated, were of firm consistency, with smooth surfaces, measuring between 0.5 and 2.0 cm in diameter, asymptomatic. Palpable lymph nodes in the occipital and posterior cervical regions. Increased abdominal size was noted, with ill-defined mass (Figures 1 and 2).A biopsy of a lesion was performed and the histopathological examination revealed diffuse infiltrate in the dermis, with the presence of cells with clear cytoplasm with nuclei compressed to the periphery, characterizing signet-ring cells (Figure 3). Digestive endoscopy showed nodular and ulcerated lesions in the antrum (also biopsied). A CT scan of the abdomen revealed an infiltrating lesion, with swelling in the antrum and gastric body. The chest scan was normal.