Cutaneous Infiltrates of Acute Myelogenous Leukemia Simulating Inflammatory Dermatoses

Abstract

Some cases of specific cutaneous manifestations of acute myelogenous leukemia (AML) may mimic inflammatory dermatoses both clinically and histopathologically, presenting with an inconspicuous maculopapular eruption and with only sparse dermal infiltrates. The authors studied the histopathological and immunohistochemical features of 17 biopsies from 16 patients (11 men and 5 women, age range 15-85 years) presenting with minimal skin infiltrates as the first manifestation of AML or as first sign of recurrence after complete remission of the disease. In all cases, the diagnosis of leukemia has been confirmed by bone marrow examination. Two of these cases had been sent to one of us for second expert consultation. Patients presented with generalized, exanthematic maculopapular eruptions, sometimes with a hemorrhagic note, that were mostly interpreted clinically as drug reactions. Histopathologically, the lesions showed sparse, superficial, and mid-dermal infiltrates with minimal perivascular and periadnexal accentuation. Infiltrating cells consisted mostly of neoplastic monocytoid elements with only few reactive lymphocytes and histiocytes. Immunohistochemical stainings revealed in the majority of cases positivity for CD68 (14 of 16 patients), naphthol chloroacetate esterase (NaSDCl) (7 of 10 patients), and myeloperoxidase (6 of 9 patients). Other markers tested were positive only in a minority of cases. These cases represent a pitfall both in the clinical and in the histopathological diagnosis of cutaneous AML. Accurate morphologic and phenotypic correlation together with a high index of suspicion allows a precise diagnosis in these unconventional cases.

Pediatric Aleukemic Leukemia Cutis

“…46 Morphologically, the malignant cells are centered in the dermis and can also extend into the subcutaneous tissue. The diagnosis can also be elusive because the infiltrate can adopt a very sparse perivascular and periadnexal distribution.…”

Acute Myeloid Leukemia Presented with Severe Erythrodermia and Dermatopathic Lymphadenitis

“…Miyeloid ve lenfoid lösemilerin en sık şekli leukemia cutis olarak isimlendirilir ve papül, nodül, plak ve/veya purpura varlığı ile kolaylıkla tanınabilir (10)(11)(12). Bu bulgular genellikle altta yatan akciğer, kolon, serviks gibi solid organ maligniteleri ve miyelodisplastik sendrom gibi hematolojik bozuklukların cilt reaksiyonları şeklinde ortaya çıkan kütanöz paraneoplastik sendromlardan farklıdır.…”

Quoi de neuf en dermatologie clinique ?

“…Il y avait un très discret in ltrat périvasculaire et parfois interstitiel, peu spéci que, mais une cytologie attentive mettait en évidence des blastes monocytoïdes (le plus souvent CD68+ et parfois MPO+). Ce travail rappelle qu'un bon dermatopathologiste et quelques marqueurs peuvent conduire à un diagnostic précoce d'une LAM [39].…”