CLL/SLL with initial presentation as a longstanding cutaneous plaque: a rare case

Abstract

While chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia in the western world, it uncommonly initially presents as a cutaneous lesion. When it does, it is often found incidentally in the context of another distinct lesion. We present a case of CLL/SLL that initially presented as a solitary nodular erythematous plaque on the left flank of a healthy 60-year-old man without lymphadenopathy or constitutional symptoms. The lesion had been present for many years, but had recently begun to grow and become pruritic and painful. Excisional biopsy revealed a large nodular aggregate of variably sized CD20(dim), CD5(+), CD23(+), BCL-2(+) atypical lymphocytes in the dermis without epidermotropism. The lymphocytes were negative for BCL-1/cyclinD1, BCL-6, and CD10, and no other background lesion was identified. This constellation of biopsy findings was consistent with CLL/SLL. This case emphasizes the potential for involvement by CLL/SLL in the cutaneous biopsies of otherwise asymptomatic patients.

Small lymphocytic lymphoma mimicking primary cutaneous marginal zone lymphoma with colonization of germinal center follicles

“…Although primary cutaneous lymphomas and lymphomas arising from extracutaneous sites of origin can have essentially an identical constellation of clinical and microscopic morphologies, the presence of widely disseminated lesions at presentation is more commonly associated with extracutaneous lymphomas involving skin 1 . Nonetheless, there are unusual reports of extracutaneous lymphomas, including CLL/SLL, presenting in the skin as long‐standing solitary lesions in the context of subclinical systemic disease 18 . Therefore, all cutaneous B‐cell infiltrates that show even equivocal CD5 expression should raise consideration for an extracutaneous B‐cell lymphoma and prompt a comprehensive clinical evaluation regardless of their clinical morphology.…”

“…1 Nonetheless, there are unusual reports of extracutaneous lymphomas, including CLL/SLL, presenting in the skin as long-standing solitary lesions in the context of subclinical systemic disease. 18 Therefore, all cutaneous B-cell infiltrates that show even equivocal CD5 expression should raise consideration for an extracutaneous B-cell lymphoma and prompt a comprehensive clinical evaluation regardless of their clinical morphology.…”