Thomas Crystal G, Patel Rajiv M, Bergfeld Wilma F
University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, TX, USA.
J Cutan Pathol. 2010 Mar;37(3):390-5. doi: 10.1111/j.1600-0560.2009.01317.x. Epub 2009 Jul 13.
Myeloid leukemia cutis (LC) is the cutaneous involvement by neoplastic leukocytes of the myeloid series. Myeloid LC may occur de novo or concurrently with acute myeloid leukemias, chronic myeloid leukemias, other myeloproliferative disorders or myelodysplastic syndromes. We describe an unusual case of cytophagic S-100 protein immunoreactive leukemia cutis presenting in an 87-year-old woman without prior history of myeloid leukemia or other hematologic disorders. We outline key histologic and immunohistochemical features that aide in the diagnosis of LC. The presence of cytophagocytosis on histologic examination, a phenomenon more commonly associated with lymphoid rather than myeloid malignancies, provided a clue to the possibility of a malignant process. The atypical myeloid infiltrate showed S-100 protein positivity, an unusual finding that may be seen in LC. Although not commonly reported in LC, the presence of S-100 protein positivity and cytophagocytosis should not lead to the premature exclusion of LC as a possible diagnosis until a thorough clinical, histologic and immunohistochemical evaluation is performed. In addition, the presence of cytophagocytosis has been shown to have prognostic significance for patients with myeloid leukemia.
髓系白血病皮肤浸润（LC）是指髓系系列的肿瘤性白细胞累及皮肤。髓系LC可原发出现，或与急性髓系白血病、慢性髓系白血病、其他骨髓增殖性疾病或骨髓增生异常综合征同时发生。我们描述了一例不寻常的噬血细胞性S-100蛋白免疫反应性白血病皮肤浸润病例，该病例发生在一位87岁女性身上，她既往无髓系白血病或其他血液系统疾病史。我们概述了有助于诊断LC的关键组织学和免疫组化特征。组织学检查中存在噬血细胞现象，这一现象更常见于淋巴系统而非髓系恶性肿瘤，提示了恶性过程的可能性。非典型髓系浸润显示S-100蛋白阳性，这是在LC中可能出现的不寻常发现。虽然在LC中并不常报道，但在进行全面的临床、组织学和免疫组化评估之前，S-100蛋白阳性和噬血细胞现象的存在不应导致过早排除LC作为可能的诊断。此外，噬血细胞现象的存在已被证明对髓系白血病患者具有预后意义。
