Pediatric Aleukemic Leukemia Cutis

Abstract

Leukemia cutis (LC) denotes a cutaneous infiltration of neoplastic myeloid cells or lymphoid blasts, which can present in the setting of acute myeloid leukemia, particularly in those cases with monocytic or myelomonocytic differentiation. Rarely, cutaneous involvement by a leukemic infiltrate can occur in the absence of bone marrow or peripheral blood involvement by acute leukemia; this then is referred to as aleukemic LC (ALC). Recognition of LC is important for further classification and early diagnosis of the disease, but the diagnosis is difficult in the absence of a systemic presentation of acute leukemia. Although the molecular and cytogenetic features of ALC are poorly characterized, some have shown specific molecular alterations in common with classic forms of acute leukemias. We present 3 cases of ALC in pediatric patients.

A case of aleukemic leukemia cutis after COVID‐19 infection presenting as facial rash

“…2,4,6 Other reports of ALC in the literature have been associated with myelodysplastic syndrome without peripheral or bone marrow involvement, 7 Sweet syndrome, and therapyrelated disease in a case of metastatic osteosarcoma treated with chemotherapy and radiation. 4 On rare occasions, the presence of an isolated bilateral eyelid rash has been proven to be the manifestation of ALC. 8,9 The differential diagnosis for ALC in our patient includes ENKTL, BPDCN, and acute febrile neutrophilic dermatosis (Sweet syndrome), particularly its histiocytoid variant.…”

“…ALC most commonly precedes AML but has also been associated with B lymphoblastic leukemia/lymphoma (B‐ALL) and rare cases of T‐cell ALL 2,4,6 . Other reports of ALC in the literature have been associated with myelodysplastic syndrome without peripheral or bone marrow involvement, 7 Sweet syndrome, and therapy‐related disease in a case of metastatic osteosarcoma treated with chemotherapy and radiation 4 . On rare occasions, the presence of an isolated bilateral eyelid rash has been proven to be the manifestation of ALC 8,9 …”

“…There have also been reports of pediatric ALC with associated MLL gene rearrangement, which may then favor bone marrow transplants for treatment given the high rates of recurrence in these patients. 4…”

“…[1][2][3] ALC presents clinically as a rash with a protean appearance, and on histopathology as a malignant interstitial infiltrate of mononuclear cells in the dermis dissecting through the collagen fibers. 4 Herein, we describe a 43-year-old woman who underwent a dermatologic examination for a facial rash 1 month after COVID-19 infection.…”

Cutaneous extramedullary haematopoiesis: Implications in human disease and treatment

“…Further supporting this notion are multiple observations of aleukaemic leukaemia cutis, in which myeloid progenitors are demonstrated in the skin without evidence of systemic leukaemic disease (Figures 3 and 4). [95] These findings raise the possibility that the transformed haematologic cell of origin leading to the diagnosis of some leukaemias may reside in the skin.…”