Afzal Anoshia, Mingola Phillip, Farooque Umar, Shabih Sohaib, Thomas Cody A
Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Neurology, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Oct 19;12(10):e11032. doi: 10.7759/cureus.11032.
Leukemia cutis (LC) is a manifestation of leukemia with infiltration of the dermis, epidermis, or subcutis by malignant leukocytes resulting in papules, plaques, nodules, or ulcers. It is usually associated with acute and chronic myeloid leukemia as well as T-cell acute lymphoblastic leukemia (T-ALL) but is very rare in patients with B-cell acute lymphoblastic leukemia (B-ALL). We report a case of a 58-year-old Hispanic male who presented with a non-healing leg ulcer of three months along with patches on the face, left arm, and bilateral legs with white blood cell (WBC) count of 50800/mm with 83% blasts, and flow cytometry findings of B-ALL. Punch biopsies from affected skin showed numerous dermal nodules composed of large atypical cells with open chromatin and prominent nucleoli. Immunohistochemical stains were consistent with B-ALL involving the skin and a diagnosis of LC was rendered. A high index of suspicion in relevant cases and prompt diagnosis is imperative to prevent any delays in appropriate therapy. Diagnosis in our case was aided by concurrent identification of B-ALL in the patient's peripheral blood. Since this information may not always be available, it is important to keep B-ALL in the differential any time there is a neoplastic infiltration of leukocytes in the dermis.
皮肤白血病（LC）是白血病的一种表现形式，恶性白细胞浸润真皮、表皮或皮下组织，导致丘疹、斑块、结节或溃疡。它通常与急性和慢性髓系白血病以及T细胞急性淋巴细胞白血病（T-ALL）相关，但在B细胞急性淋巴细胞白血病（B-ALL）患者中非常罕见。我们报告一例58岁西班牙裔男性患者，其腿部溃疡三个月不愈合，同时面部、左臂和双侧腿部出现斑块，白细胞（WBC）计数为50800/mm，原始细胞占83%，流式细胞术检查结果为B-ALL。对受累皮肤进行的打孔活检显示，真皮内有许多由大的非典型细胞组成的结节，这些细胞染色质开放，核仁突出。免疫组化染色结果与累及皮肤的B-ALL一致，从而做出了LC的诊断。对于相关病例保持高度怀疑并及时诊断对于防止适当治疗的任何延误至关重要。我们病例的诊断得益于同时在患者外周血中发现B-ALL。由于并非总能获得此类信息，因此每当真皮出现白细胞肿瘤浸润时，在鉴别诊断中考虑B-ALL很重要。
