Leucemia cutis: presentación no habitual de una enfermedad conocida

RESUMEN La leucemia es una proliferación neoplásica de las células progenitoras del origen tejido hematopoyético y se conoce como leucemia cutis a toda la infiltración en de la piel por el proceso neoplásico. Se presenta el caso de una mujer de 60 años de edad con un cuadro de tres semanas de evolución de aparición de pápulas y placas eritemato-violáceas, inicialmente tratada como cuadro alérgico. Su diagnóstico final fue leucemia cutis secundaria a leucemia mieloide aguda, presentando evolución clínica tórpida.

ABSTRACT Leukemia is a neoplastic proliferation of progenitor cells of hematopoietic tissue origin and the infiltration of the neoplastic process into the skin is known as leukemia cutis. We present the case of a 60-year-old woman with a three-week history of the appearance of erythematous-violet papules and plaques, initially treated as an allergic condition. Her final diagnosis was leukemia cutis secondary to acute myeloid leukemia, presenting a torpid clinical course.

Cutaneous leukemic infiltration following varicella - a case of Wolf's isotopic response

Abstract Wolf's isotopic response designates the appearance of two subsequent unrelated dermatoses in the same anatomic location. We report the case of a 51-year-old man with a medical history of chronic lymphocytic leukemia without known extra-hematopoietic involvement. The patient developed a disseminated papulo-vesiculous eruption, diagnosed as varicella. Few days after recovering, an erythematous and violaceous papular dermatosis with histopathological examination compatible with leukemic infiltration appeared on the scars of previous herpetic lesions. Complete remission was obtained under systemic corticotherapy, without cutaneous recurrence or blastic transformation. Wolf's isotopic response is attributed to a localized immunologic imbalance following a certain stimulus. In this patient, herpetic infection acted as a local spur for inaugural cutaneous leukemic infiltration, with no impact on the prognosis for the underlying disease.

Relapse of Biphenotypic Acute Leukemia as a Breast Mass / 한국유방암학회지

In acute leukemia, leukemic infiltration of the breast is extremely rare. We report a case of biphenotypic acute leukemia (BAL) that presented as a breast mass. A 30-year-old woman presented with a 4-month history of a right breast mass with nipple discharge and easy fatigue. She had received chemotherapy and peripheral blood stem cell transplantation for BAL and had been in complete remission for the last 2 years. Core needle biopsy of the breast mass revealed monomorphous infiltrates of blast cells with round nuclei and fine chromatin, consistent with leukemic infiltration. Subsequent bone marrow biopsy showed diffuse infiltration of immature cells. However, bone marrow karyotyping showed 46, XY, suggesting complete engraftment of transplanted donor cells. This is the report of BAL recurring as a breast mass. In the differential diagnosis of a breast mass, extramedullary relapse should be considered when the patient has a history of leukemia.

Expression of E-cadherin on bone marrow mononuclear cell surface and in plasma of patients with extra-myeloid leukemia and their clinical significance / 白血病·淋巴瘤

Objective To investigate the expression and clinical significance of soluble E-cadherin (sE-cad) and E-cadherin (E-cad) in acute leukemia (AL), and to explore their relationship with the pathogenesis,development and diagnosis of extra-myeloid leukemia. Methods 87 newly diagnosed or relapsed AL patients (19 cases of L1, 29 L2, 14 M2, 20 M3, 4 M4, 1 M5) were collected from hospitalized patients in hematology department of Harbin Medical University Cancer Hospital. The plasma from 20 healthy volunteers was used as control group. The bone marrow was from 15 non-AL patients hospitalized in hematology department (7 cases of thrombocytopenic purpura, 4 iron deficiency anemia, and 4 fever). The expression of sE-cad in the plasma of 47 patients and 20 healthy volunteers was detected by ELISA; the expression of E-cad on the membrane surface of bone marrow MNC in 40 patients and 15 controls was determined by flow cytometry. Results The plasma level of sE-cad in AL group was significantly higher than that in healthy control group [(66.812±52.712) ng/ml vs. (17.976±14.206) ng/ml, P<0.01]. The plasma level of sE-cad in extra-myeloid infiltration AL group was significantly higher than that in no-extra-myeloid infiltration AL group [(83.545±60.759) ng/ml vs. (42.152±22.043) ng/ml, P<0.01]. The plasma level of sE-cad in high leukocytes AL group was higher than that in no-high leukocytes AL group [(85.166±57.828) ng/ml vs. (41.933±32.064) ng/ml, P<0.05]. The percentage of E-cad expression in AL group was significantly lower than that in control group [(13.615±14.038) % vs. (31.700±16.213) %, P<0.01]. The percentage of E-cad expression in no-extra-myeloid infiltration AL group was significantly higher than that in extra-myeloid leukemia infiltration AL group[(18.691±14.917) % vs. (6.589±8.959) %,P<0.01]. The percentage of E-cad in no-high-leukocytes AL group was significantly higher in high leukocytes AL group [(20.925±12.081) % vs. (7.446±11.118) %, P<0.01]. Conclusions The expression of E-cad on the membrane surface of bone marrow MNC and the expression of sE-cad in plasma may be closely associated with the occurrence of extra-myeloid leukemia and leukocytosis, which may be one of the important molecular mechanisms of leukemic cell infiltration and leukocytosis. High expression of sE-cad in plasma can be treated as one of index to diagnose extra-myeloid leukemia.

Microenvironment for leukemia extramedullary infiltration / 国际肿瘤学杂志

Extramedullary infiltration is one of the reasons of relapse and death for leukemia patients.Reaearches increasingly show that extramedullary microenvironment plays a pivotal role on progress and relapse of leukemia.Extramedullary infiltration of leukemia is the result of interactions among many factors and many steps,involving liver,spleen,central nervous system,thymus and other tissues and organs.

Blastic plasmacytoid dendritic cell neoplasm / Neoplasia blastica de celulas dendriticas plasmocitoides

Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive hematodermic neoplasia with frequent cutaneous involvement and leukemic dissemination. We report the case of a 76-year-old man with a 2 month history of violaceous nodules and a tumor with stony consistency, located on the head, and mandibular, cervical and supraclavicular lymphadenopathies. Multiple thoracic and abdominal adenopathies were identified on computerized tomography. Flow cytometry analysis of the skin, lymph node and bone marrow biopsies demonstrated the presence of plasmocytoid dendritic cell neoplastic precursor cells (CD4+, CD45+, CD56+ and CD123+ phenotype). After initial clinical and laboratorial complete remission with chemotherapy, the patient died due to relapse of the disease associated with the appearance of a cervical mass with medullary compromise.

A neoplasia blástica de células dendríticas plasmocitóides é uma neoplasia hematodérmica rara, agressiva, com frequente envolvimento cutâneo e disseminação leucêmica. Relatamos o caso de um homem de 76 anos com quadro clínico com 2 meses de evolução caracterizado por nódulos e tumor de tonalidade violácea, de consistência pétrea, localizados na cabeça, e linfadenopatias mandibular, cervicais e supraclaviculares. Identificaram-se múltiplas adenopatias torácicas e abdominais em tomografia computorizada. A análise por citometria de fluxo de biópsias cutânea, ganglionar e óssea demonstrou a presença de precursores neoplásicos das células dendríticas plasmocitóides (fenótipo CD4+, CD45+, CD56+ e CD123+). Após remissão clínica e laboratorial completa inicial com quimioterapia, veio a falecer por recaída da doença associada ao aparecimento de massa cervical com compromisso medular.

Renal Insufficiency Secondary to Leukemic Infiltration in Chronic Lymphocytic Leukemia: A Case Report / 대한내과학회지

Renal infiltration is common in chronic lymphocytic leukemia (CLL), but renal impairment caused by leukemic infiltration is rare. This report describes the case of a 38-year-old man with CLL who required no medical treatment for 1 year and was admitted with nonoliguric renal insufficiency (proteinuria > 2,000 mg/day). A renal biopsy subsequently revealed leukemic infiltration by CLL. Treatment with fludarabine plus cyclophosphamide resulted in the improvement of renal function. Leukemic infiltration should be considered in the differential diagnosis of a patient with CLL and impaired renal function because renal impairment often responds well to chemotherapy.

Congenital Acute Myeloid Leukemia with t(8;16) and t(17;19) Double Translocation: Case Presentation and Literature Review

Congenital leukemia is uncommon and excluding transient myeloproliferation associated with Down syndrome, makes up approximately 1% of childhood leukemias. A newborn boy was born with multiple subcutaneous nodules and large purpuric papules. Skin biopsy revealed proliferation of atypical hematologic cells in the dermis. Bone marrow morphology was consistent with acute myeloid leukemia (M5) and cytogenetic studies revealed t(8;16) and t(17;19) double translocation. Although prognosis of congenital leukemia is known to be dismal, recent reports showed spontaneous remissions. With the fear of chemotherapy-related toxicity, to treat or not to treat may be a dilemma both to parents and pediatricians. We report our experience and review the literature.

A Case of Leukemic Infiltration of Parotid Gland Preceding the Clinical Onset of Acute Lymphoblastic Leukemia / 대한이비인후과학회지

Extramedullary leukemic infiltration rarely occurs in patients with acute lymphoblastic leukemia. An eight-year-old boy presented with a mass lesion of the left parotid gland with several palpable lymph nodes in the ipsilateral neck. The patient did not have any previous medical history. Given the suspicion of a lymphoma, an excisional biopsy of the parotid mass was performed. The preliminary pathologic result indicated myeloid sarcoma. The patient subsequently underwent bone marrow biopsy, and was finally diagnosed as acute lymphoblastic leukemia. Here we report a case of leukemic infiltration of the parotid gland as an extramedullary manifestation preceding the clinical onset of acute lymphoblastic leukemia.

A Case of Acute Lymphoblastic Leukemia Accompanied with Lactic Acidosis and Kidney Enlargement / 대한혈액학회지

There have been several reported cases of acute lymphoblastic leukemia with severe lactic acidosis in adults. In these cases, kidney and liver enlargement that was caused by leukemic infiltration frequently accompanied the acute lymphoblastic leukemia and severe lactic acidosis. Chemotherapy is the only treatment that can rapidly correct the lactic acidosis and normalize the liver and kidney enlargement. We report here on a case of acute lymphoblastic leukemia that was accompanied with severe lactic acidosis and kidney enlargement.

Bone marrow stromal cells isolated from leukemia patients promotes the invasion capacity of SHI-1 cells in vitro and its underlying mechanism / 肿瘤

Objective: To investigate the effects of bone marrow stromal cells (BMSCs) isolated from leukemia patients on the invasion capacity leukemia SHI-1 cells in vitro and the underlying mechanism. Methods: BMSCs were isolated from leukemia patients and their conditional culture medium were collected. The expressions of extracellular matrix metalloproteinase inducer (EMMPRIN) in SHI-1 cells and BMSC were detected by RT-PCR. The BMSC and SHI-1 cells were mixed at 1: 10 and inoculated in Matrigel-coated transwells. Then CXC chemokine receptor 4 (CXCR4, final concentration of 2 μg/mL) or functional antibody of EMMPRIN were added. The BMSC cultured medium was used as control on cell invasion test. The alteration of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase 2 (TIMP-2), and CXCR4 mRNA were determined by real-time PCR before and after co-culture of SHI-1 cells and BMSC. The content of stromal cell-derived factor 1 (SDF-1) in serum-free supernatent was measured by ELISA. Results: Both SHI-1 and BMSC expressed EMMPRIN. The invasion capacity of SHI-1 cells increased significantly after co-culture with BMSC, which could be blocked by CXCR4 and functional antibody of EMMPRIN. The cultured medium of BMSC did not increase the invasion capacity of SHI-1 cells. The mRNA expression levels of MMP-2, MMP-9, TIMP-2, and CXCR4 as well as SDF-1 contents in serum-free supernatent increased significantly after the SHI-1 cells were co-cultured with BMSC. Conclusion: When BMSC islated from leukemia patients contacted with leukemia SHI-1 cells, they increases the invasion capacity of SHI-1 cells through multiple molecule pathways on the surface of them on cell invasion test. It may be an important mechanism responsible for the invasion of leukemia cells to the outer space of bone marrow.

Renal Involvement of Chronic Myelogenous Leukemia Presenting as a Kidney Tumor

Renal involvement by leukemic cells is rare in chronic myelogenous leukemia (CML). Herein, this study reports a case of CML associated with renal involvement of leukemic cells, which occurred 1 and 1/2 years after the initial diagnosis. Abdomino-pelvic computed tomography revealed a 4.4 x4.2 cm-sized, low-density solid mass having a thick wall from the mid to lower pole of the left kidney. A peripheral blood analysis revealed blastic transformation of CML. The biopsied renal parenchyme was diffusely infiltrated by sheets of immature myeloid cells, polymorphonuclear leukocytes, and occasional eosinophils. Most of the infiltrating cells were positive for anti-neutrophil elastase, but negative for lymphoid markers. Therefore, differential diagnosis of a kidney tumor during the course of CML, especially in the time of blastic transformation, should be performed.

Complete Urinary Retention due to Leukemic Infiltration of the Prostate: A Case of Acute Myeloid Leukemia / 대한비뇨기과학회지

Obstructive uropathy due to leukemic infiltration of the prostate is a rare condition. A case of acute myeloid leukemia who was a 24 year old soldier, complained of difficulty of urination from early stage of the disease and later showed complete urinary retention is presented. Autopsy demonstrated slightly swollen, whitish yellow and infiltrated prostate. Histopathological findings revealed striking round cell infiltrations in the prostatic stroma and the bladder neck.