A Case of Aleukemic Leukemia Cutis

ABSTRACT

Aleukemic leukemia cutis is a rare condition characterized by invasion of leukemic cells in the skin before their appearance in the peripheral blood or bone marrow. We report a case of a 24-year-old man who presented with a 2-month history of nodules on his chin and left thigh. His medical history included acute myelocytic leukemia which had been in complete remission for 13 years and seminoma of the right testis which had been treated with orchiectomy 1 year before. Biopsy of the cutaneous lesions revealed infiltrating cells characterized by irregular shaped or kidney bean-shaped nuclei with abundant pale, slightly eosinophilic cytoplasm. These atypical cells stained positive for leukocyte common antigen, lysozyme and myeloperoxidase. His peripheral blood examination and bone marrow biopsy failed to demonstrate leukemic changes. With these results, a diagnosis of aleukemic leukemia cutis was made. We then performed another immunohistochemical stain for lysozyme and myeloperoxidase on the testicular specimen which had been diagnosed as seminoma 1 year previously. The tumor cells of seminoma were lysozyme- and myeloperoxidase-positive. We were also able to diagnose seminoma as isolated granulocytic sarcoma. A complete remission of the cutaneous lesion was achieved with chemotherapy, but recurrent leukemia cutis reappeared six months later. He underwent a bone marrow transplant but died 3 months later.