ABSTRACT
Aleukemic leukemia cutis is a rare condition characterized by the infiltration of the skin by leukemic cells before their appearance in the peripheral blood or bone marrow. We report here a 62-year-old seemingly healthy patient who presented with disseminated erythematous maculae. A skin biopsy showed leukemia cutis of monocytic type. No involvement of bone marrow or peripheral blood was found. The patient developed acute monocytic leukemia 7 months later. We present this case to illustrate how leukemia cutis can masquerade as a clinically benign-appearing cutaneous eruption without leukemic changes in blood or bone marrow. To confirm the diagnosis of aleukemic leukemia cutis, immunohistochemistry of the skin lesions as well as a complete staging procedure is necessary.
Subject(s)
Exanthema/pathology , Leukemia, Myelomonocytic, Acute/pathology , Leukemia/pathology , Skin Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Biopsy, Needle , Diagnosis, Differential , Exanthema/diagnosis , Female , Follow-Up Studies , Humans , Immunohistochemistry , Leukemia/diagnosis , Leukemia/drug therapy , Leukemia, Myelomonocytic, Acute/diagnosis , Leukemia, Myelomonocytic, Acute/drug therapy , Middle Aged , Skin Neoplasms/diagnosis , Skin Neoplasms/drug therapyABSTRACT
The detection of circulating melanoma cells has been the subject of numerous investigations in recent years. We developed a cellular approach to identifying circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. The examination covered 205 blood samples from 155 melanoma patients and 30 samples from healthy persons and nonmelanoma patients. After density gradient centrifugation, the interphase was incubated with the 9.2.27 antibody. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-anti-alkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per milliliter of whole blood could be detected reliably. Circulating melanoma cells were not found in 30 controls, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and disseminated disease, circulating 9.2.27-positive cells could be detected in 3 of 29 patients (10%) and 13 of 85 patients (15%) examined, respectively. We conclude that immunomagnetic cell sorting is a promising method with high sensitivity and specificity. The method is not suitable for early detection of metastases but is a valuable tool for further investigating the biological characteristics of circulating melanoma cells.
Subject(s)
Melanoma/diagnosis , Neoplastic Cells, Circulating/pathology , Skin Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Alkaline Phosphatase , Biomarkers, Tumor/blood , Cell Separation , Chondroitin Sulfates/immunology , Female , Humans , Immunomagnetic Separation/methods , Leukocytes , Male , Middle Aged , Neoplasm Staging , Tumor Cells, CulturedABSTRACT
Subcutaneous panniculitic T-cell lymphoma is categorized as a subtype of peripheral T-cell lymphoma. Patients typically present with nontender subcutaneous nodules. The characteristic histologic features include the presence of atypical lymphocytes and benign macrophages that infiltrate between the adipocytes of the subcutis mimicking panniculitis. We report a 75-year old patient with a three week history of asymptomatic subcutaneous nodules. The diagnosis of subcutaneous T-cell lymphoma was confirmed by immunohistological and molecular biological studies. Chemotherapy had to be interrupted due to a rapid worsening of the patient's general condition. She died few weeks after confirmation of diagnosis.
Subject(s)
Lymphoma, T-Cell, Peripheral/diagnosis , Panniculitis/diagnosis , Soft Tissue Neoplasms/diagnosis , Aged , Disease Progression , Fatal Outcome , Female , Humans , Lymphoma, T-Cell, Peripheral/pathology , Neoplasm Staging , Panniculitis/pathology , Skin/pathology , Soft Tissue Neoplasms/pathologyABSTRACT
We developed a cellular approach to the identification of circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. One hundred seventy-eight blood samples from 129 melanoma patients and 30 samples from healthy persons and nonmelanoma patients were examined. After density gradient centrifugation the interphase was incubated with the mAb 9.2.27. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-antialkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per ml whole blood could be detected reliably with the assay. Circulating melanoma cells were not found in 30 controls examined, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and in patients with disseminated disease, circulating 9.2.27-positive cells could be detected in 3 out of 22 patients (13.6%) and 10 out of 66 patients (15.2%) examined. We present a sensitive and specific immunocytological approach to detect circulating melanoma cells in peripheral blood. The method is not suitable for early detection of metastases but is a valuable tool for further investigating biological characteristics of circulating melanoma cells.
