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B-Cell Acute Lymphoblastic Leukemia Presenting as Leukemia Cutis: A Case Report
Anoshia Afzal1, Phillip Mingola1, Umar Farooque2
1Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Cureus
|November 20, 2020
Summary
Leukemia cutis (LC) is a rare skin manifestation of B-cell acute lymphoblastic leukemia (B-ALL). This case highlights the importance of considering B-ALL in skin lesions with atypical cells for prompt diagnosis and treatment.
Area of Science:
- Dermatology
- Hematology
- Oncology
Background:
- Leukemia cutis (LC) is a skin infiltration by malignant leukocytes, typically associated with myeloid leukemias and T-cell acute lymphoblastic leukemia (T-ALL).
- LC is exceptionally rare in B-cell acute lymphoblastic leukemia (B-ALL).
Observation:
- A 58-year-old male presented with a chronic leg ulcer and skin patches on the face and limbs.
- Elevated white blood cell count (50,800/mm³) with 83% blasts and flow cytometry confirmed B-ALL.
- Skin biopsies revealed dermal nodules with atypical cells consistent with leukemic infiltration.
Findings:
- Immunohistochemical stains confirmed B-ALL involvement of the skin, establishing a diagnosis of LC.
- The diagnosis was supported by concurrent peripheral blood findings of B-ALL.
Implications:
- This case underscores the necessity of a high index of suspicion for LC in patients with unexplained skin lesions, particularly when accompanied by hematologic abnormalities.
- Prompt diagnosis of B-ALL-related LC is crucial for initiating timely and appropriate treatment, potentially improving patient outcomes.
- Clinicians should consider B-ALL in the differential diagnosis of neoplastic leukocytic infiltration of the dermis, even in the absence of concurrent peripheral blood findings.
