Leukemia Cutis Associated with Secondary Plasma Cell Leukemia

Abstract

Plasma cell leukemia is an uncommon, aggressive variant of leukemia that may occur de novo or in association with multiple myeloma. Leukemia cutis is the cutaneous manifestation of leukemia, and indicates an infiltration of the skin by malignant leukocytes or their precursors. Plasma cell leukemia cutis is a rare clinical presentation of leukemia. We present a man who developed plasma cell leukemia cutis in association with multiple myeloma. Cutaneous nodules developed on his arms and legs 50 days following an autologous stem cell transplant. Histopathologic examination showed CD138-positive nodular aggregates of atypical plasma cells with kappa light chain restriction, similar to the phenotype of his myeloma. In spite of systemic treatment of his underlying disease, he died 25 days after the presentation of leukemia cutis. Pub-Med was searched for the following terms: cutaneous plasmacytomas, leukemia cutis, plasma cell leukemia nodules, plasma cell leukemia cutis, and secondary cutaneous plasmacytoma. Papers were reviewed and appropriate references evaluated. Leukemia cutis in plasma cell leukemia patients is an infrequent occurrence. New skin lesions in patients with plasma cell leukemia should be biopsied for pathology and for tissue cultures to evaluate for cancer or infection, respectively. The diagnosis plasma cell leukemia cutis is associated with a very poor prognosis.

Metastatic plasma cell leukemia to the skin: a case report with review of the literature

“…The clinical lesions observed in our patient are similar to the cutaneous nodules described in a 62-year-old man with secondary PCL: erythematous, non-tender lesions with violaceus margins and small ecchimotic foci in the surface. 10 Other clinical data observed in our patient are in line with previous reports showing that primary PCL patients usually have extramedullary disease and anemia. 3-5 However, our case did not had thrombocytopenia, hypercalcemia, impaired renal function, neither increased LDH or b2 microglobulin, which are usually associated with aggressive course.…”

“…Additional four cases of primary PCL manifesting nodular skin infiltration resembling urticaria (7), or painful nodular lesions over arms, trunk and buttocks (8), or erythematous nodules on lower limbs, abdomen and shoulders (9) were reported in literature as unusual PCL presentation, as cutaneous involvement occurred at presentation of leukemia, and they were cases of leukemia cutis. The clinical lesions observed in our patient are similar to the cutaneous nodules described in a 62-year-old man with secondary PCL: erythematous, non-tender lesions with violaceus margins and small ecchimotic foci in the surface (10). Other clinical data observed in our patient are in line with previous reports (3)(4)(5) showing that primary PCL patients usually have extramedullary disease and anemia.…”

Leukemia cutis: a rare manifestation of an underlying primary plasma cell leukemia

“…It is frequently seen in patients suffering from acute myelogenous leukemia, but can also occur in association with other haematological malignancies. 6 Accurate diagnosis of leukaemia cutis has immense prognostic implications as it can establish a diagnosis in cases where leukaemia cutis is the predecessor of systemic leukemic development. It usually portends a poor prognosis with the survival of fewer than 12 months after being diagnosed.…”

“…It usually portends a poor prognosis with the survival of fewer than 12 months after being diagnosed. 6,7 Plasma cell neoplasms encompass the following entitiesclassic MM, extra medullary plasmacytoma without MM, solitary plasmacytoma of bone, and PCL. PCL accounts for 2-4% of patients with MM and 0.3% of leukemias.…”

“…10 Plasmacytomas are the clonal expansion of PCs in tissues that can be extra osseous or extra medullary. 6 Cutaneous plasmacytomas constitute around 4% of all extra medullary sites of plasmacytomas. These lesions (solitary or multiple) may occur simultaneously with soft-tissue plasmacytomas involving the other organs or be a part of the clinical manifestations of MM.…”