Unusual cutaneous manifestations of B-cell chronic lymphocytic leukemia - 07/08/11
, Michael Colgan, MD a, Dawn Marie R. Davis, MD a, Mark R. Pittelkow, MD a, Joseph P. Colgan, MD b
Reprint requests: Lawrence E. Gibson, MD, Division of Laboratory Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Abstract |
Background |
B-cell chronic lymphocytic leukemia (B-CLL) is a low-grade lymphoproliferative disorder with characteristic histomorphologic features and an identifiable immunophenotype. The skin can be involved in the context of known disease, but cutaneous signs are rarely the presenting findings.
Objective |
Evaluation of unusual clinical cutaneous presentations of B-CLL.
Methods |
We conducted a retrospective case series analysis of 3 patients with unusual cutaneous clinicopathologic presentations of B-cell chronic lymphocytic leukemia, including erythematous plaques, angiomatosis/telangiectasia, and erosive skin changes, respectively, without a previous clinical history of chronic lymphocytic lymphoma. Main outcome measures were clinical cutaneous presentations and histopathologic results in the diagnosis of underlying disease.
Results |
In the 3 cases, lesion locations were the lower cheek, lower extremity, and penis (groin region). Histomorphologic testing showed mild to dense perivascular and periadnexal lymphoid aggregates throughout the dermis and extending into the panniculus, consistent with B-CLL. The diagnosis was confirmed with immunohistochemical studies that showed coexpression of CD5 and CD20 in the neoplastic lymphocytic infiltrate.
Limitations |
None.
Conclusion |
Cutaneous manifestations are an uncommon presentation of subclinical B-CLL. Cutaneous changes were the presenting features of underlying lymphoma in all 3 cases, highlighting the importance of maintaining a high index of suspicion for a lymphoproliferative process in cases with unusual or atypical clinicopathologic features. Additional investigations into the behavior of B-CLL in the skin may elucidate further the evolution of cutaneous lesions in this disease.
Le texte complet de cet article est disponible en PDF.Key words : B-cell chronic lymphocytic leukemia, leukemic infiltration, lymphoid leukemia, lymphoproliferative disorders
Abbreviations used : B-CLL, CLL, ICAM-1, LFA-1, PCR, WBC
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 60 - N° 5
P. 772-780 - mai 2009 Retour au numéro
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