Specific skin manifestations in acute leukemia with monocytic differentiation a morphologic and immunohistochemical study of 11 cases

Abstract

Background. Monocytic differentiation is present in the myelomonocytic (M4) and monocytic (M5) type of acute myeloblastic leukemia. Infiltration of the skin in acute myelomonocytic leukemia occurs in 10–20% of patients, the skin lesions occasionally being the first symptom, even preceding monocytosis. Methods. Eleven patients with myelomonocytic (n = 2) and monocytic leukemia (n = 9) were studied who had skin manifestations. Results and Conclusions. Clinically, all patients showed disseminated papules or nodules that corresponded histologically to nodular or diffuse infiltrates of monocytoid cells, occasionally displaying a whorled pattern. The currently available antibodies for paraffin‐embedded sections (lysozyme), elastase, leukocyte common antigen (CD45), MT1 (CD43), Leu‐Mi (CD15), LN2 (CD74), MB2, MB1 (CD45RA), LN1 (w75), Mac387, L26 (CD20), UCHL1 (CDR0), MT2 (CD45RA), and KP‐1 (CD68)) and chloracetate–esterase are not more helpful in diagnosis than are the histologic findings. By contrast, the antibodies used on frozen sections (Leu‐4 (CD3), Leu‐3a (CD4), BA1 (CD24), B4 (CD19), Leu‐M5 (CD11c), Vim12 (CD11b), VimD5 (CD15), KiM6 (CD68), KIM7 (CD68), My7 (CD13), and My9 (CD33) allow the definition of a reaction pattern that is diagnostic for acute myeloid leukemia with monocytic differentiation. Cancer 1993; 71:124‐32.

Cutaneous Myeloid Sarcoma: Natural History and Biology of an Uncommon Manifestation of Acute Myeloid Leukemia

“…The reason for this is uncertain, but may involve timing of the biopsy (longer-standing lesions would presumably have a larger number of malignant cells), preferential biopsy of the center vs. the leading edge of a lesion, or some other factor. Moreover, the clinical significance of differentiating the de novo vs. secondary cases (which could, of course, have been resolved on clinical grounds) is likely of little consequence in our patients, since survival for patients in our series was almost uniformly poor; patients do not appear to have benefitted from recent innovations in chemotherapeutic regimens or bone marrow transplant, as previous studies performed over a decade ago have demonstrated similar findings (8,11).…”

“…Our data show that the distribution of lesions favors the upper body. In all series in which an appropriate level of detail was provided (7)(8)(9)(10)(11)(12)(13)(14), the most common bone marrow diagnosis was AML, and cases with myelomonocytic or monoblastic/monocytic differentiation were prominently represented. When reported, CMS was noted to follow the initial bone marrow diagnosis (6,12,13), though most patients eventually have bone marrow involvement.…”

“…This is also refiected in the medical literature (6)(7)(8)(9)(10)(11)(12)(13)(14). Like us, most series reported a male predominance, although the study of Kaddu et al (11) reports a predominance of females.…”

“…When reported, CMS was noted to follow the initial bone marrow diagnosis (6,12,13), though most patients eventually have bone marrow involvement. The pattern of skin involvement has been described previously (8,9,(11)(12)(13), and Benet et al (13) describe that cases initially presenting in the skin have a predilection for diffuse architecture, "high dense infiltrate", large cells, and high mitotic index compared to cases with secondary involvement of the skin. This finding was not observed in our cases.…”

Effloreszenzen und Blutbildveränderungen bei einem 9 Monate alten Säugling mit Glutarazidurie Typ I

“…Jedoch bei nur 2 ± 8 % der AML-Patienten treten Hautinfiltrate mit bioptisch nachweisbaren Tumorzellen auf [2,3]. In der Untergruppe der monozytären und myelomonozytären Formen sind hingegen bis zu 30 % der Erkrankten betroffen [4,5]. …”