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CLL/SLL with initial presentation as a longstanding cutaneous plaque: a rare case.
Edward Fulton1, Daisy Alapat2, Andrea Mabry3
1Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Journal of Cutaneous Pathology
|May 6, 2016
Summary
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) can rarely present as a skin lesion. This case highlights CLL/SLL presenting as a solitary skin plaque in an otherwise healthy individual.
Area of Science:
- Hematology
- Dermatology
- Oncology
Background:
- Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a common leukemia in Western countries.
- CLL/SLL typically does not present as a primary cutaneous lesion.
Observation:
- A case of CLL/SLL presented as a solitary, long-standing, but recently growing, pruritic, and painful erythematous plaque on the flank.
- The patient was a healthy 60-year-old male with no lymphadenopathy or constitutional symptoms.
Findings:
- Excisional biopsy revealed a dermal nodular aggregate of atypical lymphocytes.
- Immunophenotyping showed CD20(dim), CD5(+), CD23(+), BCL-2(+) lymphocytes, consistent with CLL/SLL.
- The lymphocytes were negative for BCL-1/cyclinD1, BCL-6, and CD10, with no other background lesion identified.
Implications:
- This case underscores the importance of considering CLL/SLL in cutaneous biopsies, even in asymptomatic patients.
- Cutaneous involvement by CLL/SLL can manifest as an isolated skin lesion.
- Early recognition of cutaneous CLL/SLL is crucial for timely diagnosis and management.
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