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      Call for Papers: Beyond Biology: The Crucial Role of Sex and Gender in Oncology

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      About Oncology Research and Treatment: 2.4 Impact Factor I 3.3 CiteScore I 0.495 Scimago Journal & Country Rank (SJR)

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      Aleukemic Leukemia Cutis Manifesting with Disseminated Nodular Eruptions and a Plaque Preceding Acute Monocytic Leukemia: A Case Report

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          Abstract

          Aleukemic leukemia cutis (ALC), a discrete tumor of leukemic cells involving the skin, may be the first manifestation of acute myeloid leukemia, preceding the onset in marrow and blood by months and years. ALC is often difficult to diagnose and is associated with a dismal prognosis. A 63-year-old male presented with nodular swellings on the face, a plaque extending over the right shoulder and multiple enlarged cervical lymph nodes. The skin biopsy of the plaque lesion showed a diffuse neoplastic infiltration extending from the dermis to subcutaneous tissue with diffuse positivity for myeloperoxidase and focal positivity for CD34 on immunohistochemical staining. The diagnosis was leukemia cutis. One month later, acute monocytic leukemia (FAB AML-M5b) was diagnosed. The patient died on the seventh month of diagnosis.

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          Clinicopathologic correlations in leukemia cutis.

          S A Buechner, N-W Su, James Li (1984)
          This clinicopathologic study involved 42 cases of leukemia cutis: 3 of acute lymphocytic leukemia (ALL), 16 of chronic lymphocytic leukemia (CLL), 12 of acute granulocytic leukemia (AGL), 3 of chronic granulocytic leukemia (CGL), 5 of acute monocytic leukemia (AML), and 3 of acute myelomonocytic leukemia (AMML). The clinical appearance of leukemia cutis included papules, macules, plaques, nodules, ecchymoses, palpable purpura, and ulcerative lesions, and these were seen in all types of leukemias. Gingival hypertrophy was seen only in AML or AMML, and erythroderma and bullous lesions of leukemic infiltration were observed only in CLL. Cutaneous leukemic lesions may be concomitant with or preceding the diagnosis of systemic leukemia. Therefore, skin biopsy may be helpful in detecting the leukemia and may facilitate the work-up. Leukemia cutis probably is a dissemination of systemic leukemia to the skin, and the demonstration of leukemia in skin is associated with a very poor prognosis.
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            Leukemia cutis. Analysis of 50 biopsy-proven cases with an emphasis on occurrence in myelodysplastic syndromes.

            T Longacre, B R Smoller (1993)
            The hematologic, cytomorphologic, and cytogenetic features of 50 cases of leukemia cutis (LC), occurring in 40 patients, are presented. The patients' ages ranged from 19 to 75 years (mean, 42 years). The primary hematologic diagnoses in these patients included acute non-lymphoblastic leukemia (ANLL), 13 patients; myelodysplastic syndrome (MDS), 19 patients; chronic lymphocytic leukemia, 3 patients; chronic granulocytic leukemia, 3 patients; and polycythemia vera, 1 patient. Leukemia cutis developed in one patient without any known prior or subsequent hematologic disorder. The 13 cases of ANLL included French-American-British types M1 (1 case), M2 (5 cases), M3 (1 case), M4 (5 cases), and M5 (1 case). Leukemia cutis preceded blood and/or bone marrow manifestations of leukemia in nine patients with MDS and one with ANLL. The interval from skin biopsy to systemic leukemia ranged from 3 weeks to 20 months (mean, 6 months). In seven patients with MDS and three patients with ANLL, LC occurred concomitantly with leukemic transformation. Only two patients with MDS and LC did not have progression to acute leukemia during the 20 and 24 months they have been observed. Diagnoses other than LC initially were considered in five of the patients. LC was characterized most often by a dense mixed cellular dermal infiltrate that circumscribed vascular and adnexal structures. Nine patients with MDS (47%) and one with ANLL (8%) had complex chromosomal abnormalities in their bone marrow samples at the time of LC. This article reports the occurrence of LC in patients with MDS and suggests that LC is an early manifestation of leukemic transformation in these patients. These results may be important in identifying high-risk patients for early interventional therapy.
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              Acute myelogenous leukemia with leukemia cutis. Eighteen cases seen between 1969 and 1986.

              H Preisler, Max H Farrell, Wameq A. Raza … (1989)
              Leukemia cutis was documented by biopsy in 18 of 877 patients (2%) with acute myelogenous leukemia (AML) seen at Roswell Park Memorial Institute (Buffalo, NY) between 1969 and 1986. French-American-British (FAB) types included four M2, one M3, ten M4, and three M5. Lysozyme was more consistently detectable in skin sections in our cases than Leu-M1, alpha-1-antitrypsin, alpha-1-antichymotrypsin, or chloroacetate esterase activity. Additional extramedullary sites of involvement were present in 16 patients, including meningeal leukemia in six. Two patients had leukemia cutis preceding bone marrow leukemia. Skin was the initial site of relapse in 11 patients, without marrow relapse, occurring as late as 5.5 years after diagnosis. Most patients in this retrospective series were treated with radiation therapy and/or palliative chemotherapy, and did poorly, with prompt bone marrow relapses and serial skin relapses. Long-term disease-free survival was achieved in the one patient whose skin relapse was treated with whole-body electron-beam radiation therapy in conjunction with reinduction and consolidation chemotherapy. Severe skin toxicity was caused by administration of Adriamycin (doxorubicin) 12 days after electron-beam irradiation in one patient, but was not seen when cytosine arabinoside was administered in doses up to 3 g/m2 in conjunction with radiation therapy. This retrospective review suggests that optimal management of AML involving skin might include whole-body electron-beam irradiation in conjunction with induction or reinduction chemotherapy without anthracyclines, followed by consolidation chemotherapy. Additionally, there should be ongoing surveillance for and treatment of extramedullary disease at other sites, including the meninges.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Oncol
                Journal ID (publisher-id): CRO
                Title: Case Reports in Oncology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Electronic): 1662-6575
                Publication date Collection: Sep-Dec 2011
                Publication date (Electronic): 22 November 2011
                Publication date PMC-release: 22 November 2011
                Volume: 4
                Issue: 3
                Pages: 547-554
                Affiliations
                [1] aDivision of Hematology, Department of Internal Medicine, Istanbul, Turkey
                [2] bDepartment of Pathology, Medical Faculty, Istanbul University, Istanbul, Turkey
                [3] cDivision of Hematology, Department of Internal Medicine, Istanbul Bilim University, Istanbul, Turkey
                Author notes
                *Yonal Ipek, Istanbul Üniversitesi Istanbul Tip Fakültesi, Iç Hastaliklari ABD, Hematoloji BD, TR–34104 Fatih, Istanbul (Turkey), Tel. +90 535 687 59 92, E-Mail ipekyonal@ 123456yahoo.com.tr
                Article
                Publisher ID: cro0004-0547
                DOI: 10.1159/000334745
                PMC ID: 3242712
                PubMed ID: 22187541
                SO-VID: 50b2381e-641f-45c9-a47b-f6c870bbc3be
                Copyright © Copyright © 2011 by S. Karger AG, Basel
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                History
                Page count
                Figures: 4, References: 28, Pages: 8
                Categories
                Subject: Published: November, 2011

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: leukemia cutis,aleukemic leukemia cutis,atypical monocytoid cells,disseminated nodular eruptions,acute monocytic leukemia
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: leukemia cutis, aleukemic leukemia cutis, atypical monocytoid cells, disseminated nodular eruptions, acute monocytic leukemia

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