Acute myelomonocytic leukemia presenting as a primary cutaneous lymphoma of true histiocytes

Simultaneous presentation of acute monoblastic leukemia and mantle cell lymphoma: case report and review of the literature

This paper reports a 73-year old woman with simultaneous presentation of acute monoblastic leukemia (acute myeloid leukemia (AML), French-American-British (FAB) type M5a) and mantle cell lymphoma. The patient presented with wasting, generalized lymphadenopathy, an extensive infiltrative rash and pancytopenia. Bone marrow and lymph node histopatholology showed extensive infiltration by leukemic monoblasts. Marrow cytogenetics revealed a complex karyotype, including t(8;16)(p11;p13). Flow cytometric immunophenotyping of peripheral blood, lymph node and bone marrow demonstrated two populations, expressing CD5, CD19, CD20 and CD22 and CD45, HLA-DR, CD13, CD33, CD14 and CD38, respectively. A focus of abnormal lymphocytes in the lymph node biopsy demonstrated BCL1 expression and t(11;14)(p11;p13) by fluorescence in situ hybridization and immunoglobulin heavy chain gene rearrangement by the polymerase chain reaction. The patient received infusional cytarabine, daunorubicin and etoposide chemotherapy, with complete remission of both the AML and the mantle cell leukemia. To the authors' knowledge, this is the first report of simultaneous presentations of AML, FAB M5a and mantle cell lymphoma. The case is discussed and the literature is reviewed.

Cutaneous true histiocytic malignancy: true histiocytic lymphoma

True histiocytic malignancies (THM) are controversial disorders that are being re-evaluated with modern cellular and molecular biology techniques. True histiocytic lymphoma (THL) is a low-incidence, poor-prognosis THM. It mainly affects the skin, gastrointestinal tract, and bone tissues. Occasionally, skin lesions are the presenting clinical features. A patient with initially cutaneous THL is described. This and other reported cases confirm that THM are a nosologic entity by themselves.

Aleukemic monocytic leukemia cutis

Aleukemic leukemia cutis is a rare condition in which leukemic cells invade the skin before they appear in peripheral blood or bone marrow specimens. Herein we describe a 67-year-old man who underwent assessment because of papules and nodules on his back and lower extremities. A biopsy of these lesions confirmed a dense, predominantly monocytic infiltrate of the dermis and subcutaneous tissue. Immunohistochemical stains were positive for CD43 (Leu-22) as well as monocytic markers. Bone marrow and peripheral blood examinations failed to reveal leukemia. Treatment was based on the results of the skin biopsy, and the patient is doing well 1 year after therapy.

Cutaneous involvement as a presenting feature of monocytic leukemia: morphological and immunohistochemical studies

The clinical and pathological findings in a patient with monocytic aleukemic leukemia presenting initially as multiple monoblastic tumors of the skin is described. The patient was a 35-year-old Japanese woman, who had first noticed multiple, asymptomatic, reddish-brown papules on her trunk. Asymptomatic enlargements of several lymph nodes were present in the bilateral cervical and axillary areas. There was no hepatosplenomegaly, sternal tenderness, bruising, or bleeding. The skin and lymph node biopsies were originally interpreted as malignant lymphoma. The diagnosis of acute monocytic leukemia was established when bone marrow involvement was detected. Immunohistochemical observation of the skin eruptions revealed the following: Positive staining with lysozyme was noted in almost half of the infiltrating atypical cells. Most of the infiltrating cells reacted positively with antisera to Leu-M5 and some of them reacted to Leu-M1. The helper T cell antibody, Leu-3a+3b, showed weak positive staining of most infiltrating cells. However, there were no reactions with antisera to Leu-6, Leu-7, Leu-14, CALLA, OKT 6, OKT 8, OKT 16, OKB 19, OKM 14, beta F1, or delta TCS1. OKM 5-positive keratinocytes were observed in some parts of the upper epidermis, although no OKM 5 expression could be detected on any tumor cells. Cytochemistry, immunohistochemistry, and electron microscopy can aid in the diagnosis of monocytic leukemia. This case illustrates the importance of using an expanded panel of monoclonal antisera in certain hematopoietic tumors.

Aleukemic leukemia cutis

A 39-year-old man had multiple nodules on the skin. The appearance of atypical monocytes in a skin biopsy specimen preceded the onset of overt acute monocytic leukemia by 14 months.

Dermal monocytic sarcoma/monoblastic tumour: report of two cases of acute monocytic leukemia with initial dermal manifestations only

The clinical and pathological findings in 2 patients with acute monocytic leukemia (AMOL) presenting initially as multiple monoblastic tumours of the skin (monocytic sarcoma) were reviewed. The skin biopsies were originally interpreted as malignant lymphoma and the diagnosis of AMOL was established when overt bone marrow and/or peripheral blood involvement was detected. The time interval from initial skin biopsy to either blood or bone marrow involvement by AMOL was 2 and 18 mth. After diagnosis of extracutaneous dissemination, survival was less than 1 mth. Cytochemistry, immunohistochemistry and electron microscopy can aid in the diagnosis of a monocytic sarcoma. Generally, the most practical way to confirm the diagnosis, in everyday practice, on fixed paraffin-embedded tissues is the demonstration of alpha-1-antitrypsin (A1AT) and/or lysozyme by the immunoperoxidase technique.

Specific cutaneous involvement in the course of chronic myelomonocytic leukemia simultaneously with blastic leukemic transformation. Report of a case with histologic and cytochemical study

We report a case, in a 74-year-old man, of chronic myelomonocytic leukemia (CMML) that showed cutaneous involvement in its terminal phase. The patient developed a nodular eruption with an irregular distribution over the entire skin surface. Histology showed an acute leukemic infiltration in the reticular dermis. We were able to demonstrate cells with intermediate myeloid and monocytic characteristics ("paramyeloid cells") in the skin biopsy and in bone marrow smears. There have been only four patients reported previously with similar clinical findings. In one of them the cutaneous eruption heralded an aggressive clinical shift of the disease, as in our case. The present case confirms the utility of skin biopsy in similar cases for predicting the evolution of the disease.

The intracutaneous growth of murine lymphomas: epidermal invasion is characteristic of multiple tumor phenotypes

Affinity of lymphoid cells for the epidermis (epidermotropism) is characteristic of the cutaneous T-cell lymphomas, mycosis fungoides and the Sézary syndrome. Consistent with numerous studies indicating that mycosis fungoides is a neoplasm of OKT4+T8- ("helper/inducer") T lymphocytes is the possibility that epidermotropism is a phenotypic hallmark of this subset of malignant T cells. This proposal was investigated in mice using 8 phenotypically characterized lymphomas of BALB/c origin: 3 histiocytic (phagocytic, lysozyme-positive, FcR+, Ig-, Thy 1-), 1 B-cell (IgM+, FcR+, Thy 1-), and 4 T-cell (Ig-, Thy 1+) lines, including 1 with markers of mouse helper/inducer T cells (Lyt1+23-), 2 with suppressor/cytotoxic markers (Lyt1-23+), and 1 with markers of immature thymocytes (Lyt1+23+). The intracutaneous growth pattern of these lines was studied on hematoxylin and eosin-stained sections through the centers of tumors obtained at times after intradermal injection into parallel groups of syngeneic mice. All of these lymphomas manifested variable epidermotropism that followed a typical sequence. Following dermal growth and spread to the dermal-epidermal junction, tumor cells appeared within the stratum spinosum. Subsequently, collections of cells appeared in spaces within the epidermis (Pautrier-like microabscesses) in tumors greater than 2 cm in diameter, coincident with early epidermal necrosis. Thus, in this animal model it is clear that the intraepidermal invasion/growth does not correlate with the helper/inducer T-cell surface phenotype. These observations are nonetheless consistent with recent studies using monoclonal antibodies to cell surface antigens which have demonstrated a heterogeneity of lymphoid cell subsets within the epidermis in lesions of mycosis fungoides and of other malignant and benign dermatoses.