Robak Ewa, Robak Tadeusz
Department of Dermatology and Venereology, Medical University of Lodz, Poland.
Leuk Lymphoma. 2007 May;48(5):855-65. doi: 10.1080/10428190601137336.
Cutaneous lesions occur in up to 25% of patients with chronic lymphocytic leukemia (CLL). These can be caused by either cutaneous seeding by leukemic cells (leukemia cutis, LC) and other malignant diseases or nonmalignant disorders. Skin infiltration with B-lymphocyte CLL manifests as solitary, grouped, or generalized papules, plaques, nodules, or large tumors. Prognosis in CLL patients with LC is rather good and many authors claim that it does not significantly affect patients' survival. However, prognosis is poor in patients in whom LC shows blastic transformation (Richter's syndrome) and when leukemic infiltrations in the skin appear after the diagnosis of CLL. Secondary cutaneous malignancies are also frequent complications in patients with CLL. A higher risk was seen in skin cancer, for which eightfold higher occurrence has been stated. There are some suggestions that alkylating agents and purine analogs may be associated with an increased incidence of secondary malignancies in CLL. Nonspecific, secondary cutaneous lesions are frequently observed in CLL patients. The most common secondary cutaneous changes seen in CLL are those of infectious or hemorrhagic origin. Other secondary lesions present as vasculitis, purpura, generalized pruritus, exfoliative erythroderma, and paraneoplastic pemphigus. An exaggerated reaction to an insect bite and insect bite-like reactions have been also observed.
高达25%的慢性淋巴细胞白血病（CLL）患者会出现皮肤病变。这些病变可能由白血病细胞的皮肤播散（皮肤白血病，LC）以及其他恶性疾病或非恶性疾病引起。B淋巴细胞型CLL的皮肤浸润表现为孤立性、群集性或全身性丘疹、斑块、结节或大肿瘤。伴有LC的CLL患者预后相当良好，许多作者称其不会显著影响患者的生存。然而，LC发生母细胞转化（ Richter综合征）的患者以及在CLL诊断后出现皮肤白血病浸润的患者预后较差。继发性皮肤恶性肿瘤也是CLL患者常见的并发症。皮肤癌的风险更高，其发生率已被指出高出八倍。有一些迹象表明，烷化剂和嘌呤类似物可能与CLL继发性恶性肿瘤的发生率增加有关。CLL患者经常出现非特异性继发性皮肤病变。CLL中最常见的继发性皮肤变化是感染性或出血性起源的变化。其他继发性病变表现为血管炎、紫癜、全身性瘙痒、剥脱性红皮病和副肿瘤性天疱疮。还观察到对昆虫叮咬的过度反应和类似昆虫叮咬的反应。
