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Trepanowski N, Cavanaugh-Hussey MW, Dufner RY, Eichstadt S, Lin WM, Shi CR, Mahalingam M, Hartman RI. Erythroderma in a patient with chronic myelomonocytic leukemia. JAAD Case Rep 2022; 26:61-65. [PMID: 35880025 PMCID: PMC9307897 DOI: 10.1016/j.jdcr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, Massachusetts.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Margaret W Cavanaugh-Hussey
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Dermatology Section, VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
| | | | - Shaundra Eichstadt
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts
| | - William M Lin
- Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Connie R Shi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Meera Mahalingam
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts.,Department of Pathology and Laboratory Medicine, Dermatopathology Section, VA Integrated Service Network (VISN-1), West Roxbury, Massachusetts
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Dermatology Section, VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
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Azari-Yaam A, Safavi M, Ghanadan A. Aleukemia cutis: Clinicopathological and molecular investigation of two cases. J Cutan Pathol 2020; 47:747-754. [PMID: 32196719 DOI: 10.1111/cup.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Abstract
We describe two cases of acute myeloid leukemia (AML) who presented with cutaneous manifestations. Leukemia cutis (LC) is the cutaneous presentation of any type of leukemia and occurs in 10% to 15% of patients with AML, but cutaneous infiltration of AML rarely precedes the involvement of the bone marrow or peripheral blood and is called "aleukemia cutis." Our first case presented with facial skin thickening, a manifestation which is known as lionization and his initial clinical diagnosis was nonspecific allergic reaction. Our second case presented with urticaria-like lesions with the initial clinical and histomorphologic diagnoses of leukocytoclastic vasculitis. Histopathologic examination of skin biopsy specimens in both patients showed diffuse infiltration of the dermis with a monotonous population of intermediate-sized mononuclear cells by open chromatin and promonocytic features. Bone marrow aspiration leukocyte karyotyping showed normal cytogenetics, and molecular investigation revealed mutations of NPM1 and FLT3 genes. Somatic CEBPA gene mutation was negative in both patients. LC as the first manifestation of leukemia is very rare and could result in delayed diagnosis and affect patient prognosis.
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Affiliation(s)
- Aileen Azari-Yaam
- Molecular Pathology and Cytogenetics Division, Department of Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moeinadin Safavi
- Molecular Pathology and Cytogenetics Division, Department of Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghanadan
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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3
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Rallis E, Stavropoulou E, Michalakeas I, Papadakis P, Poziopoulos C. Monoblastic sarcoma cutis preceding acute monoblastic leukemia. Am J Hematol 2009; 84:590-1. [PMID: 19051330 DOI: 10.1002/ajh.21326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Rothe MJ, Bernstein ML, Grant-Kels JM. Life-threatening erythroderma: diagnosing and treating the “red man”. Clin Dermatol 2005; 23:206-17. [PMID: 15802214 DOI: 10.1016/j.clindermatol.2004.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exfoliative erythroderma, or diffuse erythema and scaling of the skin, may be the morphologic presentation of a variety of cutaneous and systemic diseases. Establishing the diagnosis of the underlying disease is often difficult and, not uncommonly, erythroderma is classified as idiopathic. Several cases are presented to demonstrate the diversity of presentation of this disease. Laboratory findings are typically unhelpful in establishing the etiology of erythroderma. Clinical data combined with multiple skin biopsies over time are necessary. Systemic complications of erythroderma include infection, fluid and electrolyte imbalances, thermoregulatory disturbance, high output cardiac failure, and acute respiratory distress syndrome. The initial approach to the management of erythroderma of any etiology includes attention to nutrition, fluid and electrolyte replacement, and the institution of gentle local skin care measures. Oatmeal baths and wet dressings to weeping or crusted sites should be followed by application of bland emollients and low-potency topical corticosteroids. Systemic dermatologic therapy may be required to maintain improvement achieved with local measures or to control erythroderma refractory to local measures. The prognosis of erythroderma is dependent on the underlying etiology.
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Affiliation(s)
- Marti Jill Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Pont V, Miquel FJ, Grau TC, Hernández F, Sánchez-Carazo JL, Aliaga A. Skin involvement in chronic myelomonocytic leukaemia as a predictor of transformation into acute myeloid leukaemia. J Eur Acad Dermatol Venereol 2001; 15:260-2. [PMID: 11683295 DOI: 10.1046/j.1468-3083.2001.00231.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report on the case of a patient with myelodysplastic syndrome (MDS) who presented with leukaemia cutis preceding development of acute myeloid leukaemia. Leukaemic infiltration of the skin should be considered an early manifestation of leukaemic transformation and an indicator of poor prognosis in MDS.
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Affiliation(s)
- V Pont
- Department of Dermatology, Hospital General Universitario, Valencia, Spain
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Yavorkovsky LL, Zain J, Wu CD, Trivelli L, Cook P. Monocytic leukemia cutis diagnosed simultaneously with refractory anemia with monocytosis: a case report. Am J Hematol 2001; 66:120-2. [PMID: 11421290 DOI: 10.1002/1096-8652(200102)66:2<120::aid-ajh1027>3.0.co;2-v] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A case of leukemia cutis (LC) of monocytic lineage in a patient with myelodysplastic syndrome (MDS) is presented. Cutaneous infiltrates were recognized concurrent with diagnosis of refractory anemia (RA) with monocytosis. Skin infiltrates subsequently spontaneously regressed although MDS progressed with increasing monocytosis, anemia, and thrombocytopenia. Death occurred 6 months after diagnosis with evolution of acute monoblastic leukemia complicated by sepsis. This case supports previous observations of poor prognosis associated with leukemia cutis. LC associated with MDS is reviewed including the role of monocytes.
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Affiliation(s)
- L L Yavorkovsky
- Department of Medicine, The Brooklyn Hospital Center, New York 10201, USA.
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7
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Abstract
Erythroderma can be caused by a variety of underlying dermatoses, infections, and systemic diseases. Many of the findings on history, physical examination, and laboratory evaluation are nondiagnostic. Distinctive clinical and laboratory features pointing to a specific disease may be evident, however. Conclusive clinicopathologic correlation may require multiple and repeated skin biopsies. The prognosis of erythroderma has improved with the advent of innovative dermatologic therapies (e.g., cyclosporine and synthetic retinoids) and advances in the management of systemic manifestations. Death from sepsis, cardiac failure, adult respiratory distress syndrome, and capillary leak syndrome continue to be rarely reported. A high index of suspicion for these complications must be maintained to facilitate early medical intervention.
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Affiliation(s)
- M J Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, USA
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Abstract
Aleukemic leukemia cutis is a rare condition characterized by the infiltration of the skin by leukemic cells before their appearance in the peripheral blood. The authors report a case of aleukemic leukemia cutis in a 30-year-old seemingly healthy man who presented with multiple skin papulonodular lesions and lack of peripheral blood involvement. Histopathologically, the skin infiltrates showed prominent granulomatous features that masked the underlying malignant process. Immunophenotypic studies of skin and bone marrow infiltrates revealed the myelomonocytic lineage of the atypical cells, consistent with M4 acute myelomonocytic leukemia. The authors emphasize the value of immunohistochemical studies in diagnosing a cutaneous atypical infiltrate and discuss problems of histopathologic differential diagnosis.
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Affiliation(s)
- C Tomasini
- Department of Medical and Surgical Specialities, University of Turin, Italy
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Baksh FK, Nathan D, Richardson W, Kestenbaum T, Woodroof J. Leukemia cutis with prominent giant cell reaction. Am J Dermatopathol 1998; 20:48-52. [PMID: 9504669 DOI: 10.1097/00000372-199802000-00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a case of leukemia cutis associated with a prominent giant cell component. This lesion was initially diagnosed as chronic granulomatous inflammation 1 year before the definitive diagnosis of leukemia cutis was made. Skin biopsy specimens showed numerous Langhans-type giant cells occurring singly and as poorly formed granulomas. However, the majority of the infiltrate consisted of immature myeloid cells, positive for chloroacetate esterase, lysozyme, and CD 68. Subsequent peripheral blood and bone marrow examinations confirmed the progression of the disease to acute myeloid leukemia.
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Affiliation(s)
- F K Baksh
- Department of Pathology, Eastern Virginia Medical School, Norfolk 23507, USA
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Byrd JC, Edenfield WJ, Dow NS, Aylesworth C, Dawson N. Extramedullary myeloid cell tumors in myelodysplastic-syndromes: not a true indication of impending acute myeloid leukemia. Leuk Lymphoma 1996; 21:153-9. [PMID: 8907283 DOI: 10.3109/10428199609067593] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this report is to record a patient with myelodysplastic syndrome (MDS) associated acute myelogenous leukemia (AML) and leukemia cutis who had blast expression of the neural cell adhesion molecule (NCAM) and to review the world literature on prognostic implications of extramedullary myeloid cell tumors (granulocytic sarcoma, myeloblastoma, chloroma and leukemia cutis) in MDS and MDS associated AML. Case report and world literature from January 1965-January 1994 for all cases of MDS-associated extramedullary myeloid cell tumors (EMT) is reviewed, and the first patient with EMT, MDS associated AML and blast expression of NCAM is described. There have been 46 cases of MDS associated EMT previously reported. 32 cases occurred in the absence of AML. AML developed in 47% of these patients at a mean of 38 weeks from initial EMT. Of the patients not developing AML, median survival from initial EMT was 11 weeks. Nine patients received chemotherapy at the time of EMT and had a median survival of 36 weeks. The median survival for patients receiving conservative therapy for EMT was 48 weeks. Patients (n = 15) with EMT and MDS associated AML had a poor outcome regardless of therapy with a median survival of 11 weeks. Unlike other forms of isolated EMT, MDS associated EMT is not always a forerunner of AML. Premature induction therapy for MDS associated EMT does not appear to prolong survival. EMT in the setting of MDS associated AML is associated with a poor prognosis despite aggressive chemotherapy. Blast expression of NCAM may prove to be a risk factor for EMT in MDS associated AML.
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Affiliation(s)
- J C Byrd
- Division of Hematology-Oncology, Department of Internal Medicine, Walter Reed Army Medical Center and the Uniformed Services University of the Health Sciences, Washington, DC 20307, USA
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Abstract
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.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic Rochester, Minnesota 55905, USA
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13
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Ohno S, Yokoo T, Ohta M, Yamamoto M, Danno K, Hamato N, Tomii K, Ohno Y, Kobashi Y. Aleukemic leukemia cutis. J Am Acad Dermatol 1990; 22:374-7. [PMID: 2406302 DOI: 10.1016/0190-9622(90)70052-j] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- S Ohno
- Department of Dermatology, Tenri Hospital, Japan
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