Clinical and pathological features of myeloid leukemia cutis

Li, Li; Wang, Yanan; Lian, Christine G.; Hu, Nina; Jin, Hongzhong; Liu, Yuehua

doi:10.1590/abd1806-4841.20186327

Cited by 25 publications

(43 citation statements)

References 14 publications

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“…Patients with suspected LC should always undergo biopsy. But like in our case the diagnosis of LC can be challenging: Immuno-histochemistry can be very helpful in the process with MPO resembling a strong marker for myeloid cells while CD34 or CD117 remain very often negative (Traweek et al, 1993 ; Cronin et al, 2009 ; Li et al, 2018 ).…”

Section: Discussionmentioning

confidence: 72%

Cutaneous Leukemic Infiltrates Successfully Treated With Biomodulatory Therapy in a Rare Case of Therapy-Related High Risk MDS/AML

et al. 2018

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Cutaneous manifestations in hematologic malignancies, especially in leukemia, are not common and may be very variable. Here we report a very unusual case of a patient (female, 70 years old) who was admitted to the hospital in 2016 because of skin lesions on the face, the trunk of the body and the extremities. She had a history of breast cancer in the year 2004 (pT1b, pN0, cM0, L0, V0, R0) which had been resected and treated with adjuvant radiation and chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracile) as well as psoriasis treated with methotrexate and cyclosporine. Because of mild cytopenia a bone marrow aspirate/biopsy was performed showing myelodysplastic syndrome (MDS) with multilineage dysplasia. Cytogenetic review revealed a complex aberrant karyotype denoting adverse outcome. Simultaneously, a skin biopsy could confirm leukemic skin infiltration. Consequently, a therapy with azacitidine was started. After the first cycle the patient developed severe pancytopenia with a percentage of 13% peripheral blasts (previously 0–2%) as well as fever without evidence for infection which was interpreted as progressive disease. Therefore, the therapeutic regimen was changed to a biomodulatory therapy consisting of low-dose azacitidine 75 mg/day (given sc d1-7 of 28), pioglitazone 45 mg/day per os, and all-trans-retinoic acid (ATRA) 45 mg/m2/day per os. After cycle 1 of this combined biomodulatory therapy the patient showed hematologic recovery; besides a mild anemia (hemoglobin 11.1 g/dl) she developed a normal blood count. Moreover, the cutaneous leukemic infiltrates which had been unaffected by the azacitidine ameliorated tremendously after 2 cycles resulting in a complete remission of the skin lesions after cycle 6. In conclusion, we report a very unusual case with cutaneous infiltrates being the first clinical manifestation of hematologic disease, preceding the development of acute myeloid leukemia. While azacitidine alone was ineffective, a combined biomodulatory approach resulted in a complete remission of the cutaneous manifestation.

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Section: Discussionmentioning

confidence: 72%

Cutaneous Leukemic Infiltrates Successfully Treated With Biomodulatory Therapy in a Rare Case of Therapy-Related High Risk MDS/AML

et al. 2018

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“…Leukemia cutis is the infiltration of neoplastic leukocytes or their precursors into epidermis, dermis, or subcutaneous tissue [1]. The diagnosis is confirmed by skin biopsy and immunohistochemistry [2]. In most cases, there are perivascular or diffuse infiltrate, which affect dermis and subcutaneous tissue, but don't affect the upper part of papillary dermis [3].…”

Section: Discussionmentioning

confidence: 99%

“…It is defined as the infiltration of the skin by neoplastic cells or its precursors [1]. The diagnosis is confirmed by anatomopathological study of the skin and is strongly associated with acute progression and low life expectancy [2]. Some theories suggest the existence of an affinity of neoplastic cells for skin injuries, but very few cases of leukemia cutis at the site of surgical scars have been reported.…”

Section: Introductionmentioning

confidence: 99%

A Case of Leukemia Cutis in an Inguinal Herniorraphy Scar

Duarte¹,

Nieto²,

Estruch³

et al. 2020

SCR

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Leukemia cutis refers to the infiltration of the skin with leukemia cells. It is a rare extramedullary manifestation of leukemia, but it is a specific sign of disease progression and bad prognosis. Cases of leukemia cutis in sites of skin trauma or surgical scars have been described, but there are very few cases reported in literature. We report a case of a 65-year-old male previously diagnosed with chronic myelomonocytic leukemia that was showing clinical signs of progression to acute myeloid leukemia. He underwent right inguinal herniorrhaphy three months before and was showing poor wound healing. Surgical site infection was suspected, since blood tests showed prolonged neutropenia, so surgical wound debridement was performed. Pathological findings of removed tissue indicated infiltration by leukemic cells, which led to the diagnosis of leukemia cutis, not suspected until that moment. Therefore, we conclude that an exhaustive skin examination (especially in the presence of skin trauma or surgical scars), should be performed in patients with confirmed or suspected diagnosis of leukemia. Moreover, the possible diagnosis of leukemia cutis should be considered in leukemia patients who present cutaneous infectious complications or suboptimal healing following accidental skin trauma or surgery. In these cases, complementary anatomopathological studies should be performed.

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“…CMML comprises four clinicopathological variants: myelomonocytic cell tumors, mature plasmacytoid dendritic cell proliferations (MPDCP), blastic plasmacytoid dendritic cell neoplasms, and blastic indeterminate dendritic cell tumors . This heterogeneity jeopardizes the association between extramedullary cutaneous lesions and the myeloid disorder . Our patient meets the MPDCP criteria as she presented papulo‐erythematous lesions, diffuse positivity for myeloid markers (CD13, CD14) and focal expression of dendritic cell markers (CD123, MPO) .…”

mentioning

confidence: 80%

“…Leukemia cutis (LC) describes the cutaneous manifestations of leukemia . LC usually presents with nodular lesions and plaques, although the clinical‐morphological findings comprise a wide range of cutaneous manifestations . Rare manifestations include erythematous macules, blisters, and ulcers, occurring alone or in combination …”

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confidence: 99%