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JAMA Clinical Challenge |

Cutaneous Nodule in a Young Man

Jianjun Qiao, MD, PhD; Hong Fang, MD
JAMA. 2012;308(8):812-813. doi:10.1001/jama.2012.9637.
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A 21-year-old male student presents with a nodule on his chest that has been progressively enlarging over 1 month. He also has a 1-month history of upper abdominal pain associated with diarrhea but without fever or chills. He was diagnosed with acute gastroenteritis and treated with oral omeprazole and ofloxacin without relief. He has lost 5 kg during the past half year. He denies any history of chronic illness or family history of cancer. Physical examination reveals left supraclavicular and cervical lymphadenopathy. A solitary asymptomatic, nontender, and indurated nodule is found on his chest (Figure 1). Gastrointestinal endoscopy shows multiple ulcers on the gastric fundus and gastric corpus.

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Figure 1. Solitary nodule on the chest.
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Figure 2. Histology of the nodule. A, Some neoplastic cells appeared as signet ring cells. B, Immature lumens of glands (both panels: hematoxylin-eosin, original magnification ×400).
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