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An 83-year-old woman was referred to our department on suspicion of SSc, during admission in the respiratory medicine department. She had had surgery one year previously for breast cancer. Physical examination showed mildly swollen fingers with nail fold bleeding (Fig. 1a). Further examination revealed a solitary bony-hard, mobile subcutaneous nodule, sized 10-mm in diameter located on the edematous forearm (Fig. 1b). A biopsy specimen from the finger showed thickened collagen bundles in the dermis (Fig. 2a), and lipomembranous changes in the subcutaneous tissues (Fig. 2b). Another biopsy from the forearm showed edematous dermis with slightly thickened collagen bundles in the lower dermis, with lipomembranous changes in the subcutis (Figs. 2c and 2d). The nodule of the forearm was simultaneously removed, which histologically revealed a well-circumscribed tumor composed of degenerated fat cells with lipomembranous lesions surrounded by a thin fibrous capsule (Figs. 2e and 2f). Laboratory data showed normal liver and renal function and an increased level of KL-6 (3581 U/ml; normal <500). Antinuclear Letter to the Editor

Lipomembranous changes (membrano-cystic lesions) in the extremities of a patient with systemic sclerosis