Leukemia Cutis (Involving Chronic Lymphocytic Leukemia) Within Excisional Specimens: A Series of 6 Cases

Abstract

We present 6 cases of chronic lymphocytic leukemia (CLL) that incidentally involved 6 excisional specimens for biopsy-proven carcinoma. CLL was notably absent from all 5 biopsies that were available for review. In 2 of 6 cases, this was the patients' initial presentation of CLL. Five of 6 cases involved routine paraffin-embedded tissue specimens and 1 case involved frozen tissue sections from a Mohs surgical procedure. The mean age range of the patients was 84 years. Only one of 5 patients in which we have follow-up data, died of a CLL-related cause at the time of this submission (mean follow-up 19.8 months). On histologic examination, the most common pattern of involvement by CLL (as seen in 4 of the 6 cases) was a dense, nodular, and superficial and deep perivascular, periadnexal, and perineural infiltrate beneath the fibrosing granulation tissue of the prior biopsy site. The infiltrate involved the upper and deep reticular dermis and subcutaneous fat. The remaining 2 cases demonstrated a novel finding of a subtle infiltration of leukemic cells among extravasated red blood cells within the mid and deep reticular dermis. In all cases, leukemic cells were present as tightly packed, small, monomorphous, hyperchromatic lymphocytes and 1 case demonstrated a proliferation center. Immunohistochemical stains were performed on 3 of 6 cases, and the leukemic cells were CD5/CD20/CD23/CD3. This case series raises awareness that CLL can incidentally involve dermatopathology specimens and occasionally be the initial presentation of the patients' systemic illness. This series also highlights the unique histologic patterns of CLL in the skin, one of which has not been previously described, and illustrates how these patterns are distinct from the typical interstitial infiltration seen in other cases of leukemia cutis.

Leukaemia cutis – Epidemiologie, Klinik und Differenzialdiagnosen

“…Die B-Lymphoblasten der ALL erweisen sich positiv für CD79a und TdT, T-Lymphoblasten hingegen für CD1a, CD3, CD43 und TdT. Bei der CLL exprimieren die Tumorzellen beispielsweise CD5, CD19, CD20, CD43 und vereinzelt CD5 (Abbildung 9b) [29,32,66,67] [29] (Abbildung 10a). In der Immunhistochemie zeigt sich bei der AML in 50-65 % und bei der CML in 70-80 % der Fälle eine positive NASD-Färbung [29,66].…”

“…Auch beim rezidivfreien Überleben und der mittleren Zeitdauer der kompletten Remission ergaben sich keine statistisch signifikanten Unterschiede [28]. Andere Arbeitsgruppen konnten keinen direkten Zusammenhang zwischen dem Ausmaß der Hautinfiltration bei LC oder einem spezifischen histologischen Infiltrationsmuster und einer prognostischen Bedeutung herstellen [27,67]. Die molekularpathologische Diagnostik verschiedener Genmutationen (z.…”

Leukemia cutis – epidemiology, clinical presentation, and differential diagnoses

“…Nor were there significant differences in the recurrence-free survival and average duration of complete remission [28]. Other working groups have shown that there is no direct relationship between the extent of infiltration of the skin in LC or a specific histological infiltration pattern and prognostic significance [27,67]. In the future, the molecular pathological diagnosis of various gene mutations (e.g., NPM1, FLT3) will be very important for the pathogenetic interpretation and prognosis of LC and underlying forms of leukemia [33].…”

“…The B lymphoblasts in ALL are positive for CD79a and TdT, while T lymphoblasts are positive for CD1a, CD3, CD43 and TdT. In CLL the tumor cells may express CD5, CD19, CD20, CD43 and occasionally CD5 (Figure 9b) [29,32,66,67]. The cytologic appearance of individual AML forms is characterized by various monomorphic cell lines, which in myeloblastic leukemia (FAB-M 1 and -M 2 ) are characterized by medium-sized to large mononuclear cells with a light cytoplasm and large, basophilic cell nuclei.…”

Cutaneous Borreliosis With a T-Cell–Rich Infiltrate and Simultaneous Involvement by B-Cell Chronic Lymphocytic Leukemia With t(14;18)(q32;q21)

“…[9][10][11][12] An unusual but well-documented presentation is the occurrence of specific B-CLL infiltrates in the vicinity of epithelial and nonepithelial lesions, including squamous cell carcinoma, keratoacanthoma, melanoma, Merkel cell carcinoma, dermatofibroma to name but a few. [13][14][15][16][17][18] Additionally, an association of B-CLL and various cutaneous T-cell lymphomas has been documented, including MF, Sézary syndrome, peripheral T-cell lymphoma involving the skin, and natural killer-cell lymphoma. [19][20][21] Occurrence of leukemic infiltrates on the site of a previous herpes simplex or herpes zoster infection leads to the speculation that specific skin infiltrates of B-CLL can be triggered by antigenic stimulation.…”