Leukemia Cutis- A Case Report

Abstract

Leukemic cells infiltrating the dermis are referred to as leukemia cutis. Leukemia cutis is seen in myeloid and lymphoid leukemias. Granulocytic sarcoma presenting primarily as skin nodule [leukemia cutis] in CML is a rare entity. Presence of leukemia cutis points towards blast crisis and poorer prognosis even when the hematological parameters point towards a chronic phase. The authors report a case of Leukemia cutis in Chronic Myeloid Leukemia presenting with multiple large skin nodules all over the body. The clinicopathological features of this variant with FNAC cytology, skin biopsy and histopathology findings and peripheral blood smear are discussed with full details. KEY WORDS; CML, Leukemia cutis, Granulocytic sarcoma (GS). INTRODUCTION: Leukemic cells infiltrating the dermis are referred to as leukemia cutis. Leukemia cutis is seen in myeloid and lymphoid leukemias. Leukemia cutis is a rare presentation of Granulocytic sarcoma. Granulocytic sarcoma (chloroma) is formation of localized tumor mass in any part of the body, composed of granulocytic series of cells seen in myeloid leukemias. Granulocytic sarcoma is reported in 3-9% cases of acute and chronic myelogenous leukemia (1). The authors report a case of Leukemia cutis in Chronic Myeloid Leukemia presenting with multiple large skin nodules all over the body. The clinicopathological features of this variant are discussed with full details. CASE REPORT: A 33 yr old male presented with multiple cutaneous nodules over the face, back, anterior chest wall and limbs, associated with fever for duration of 3 months. The patient was referred from the dermatology department with a provisional diagnosis of leishmaniasis for FNAC of the skin nodules. On examination the skin nodules were of varying sizes ranging from 1-5 cms, largest measuring 5x3 cms and average size being 2x1 cms. The nodules were present all over the body, more on face, back, chest wall and limbs. [Fig 1]The nodules were firm to hard and non tender on palpation. FNAC was performed at multiple sites from multiple nodules. Aspiration was