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CD3/CD20/CD45 negative leukemia cutis.

Ilya Tsvetnov1, Ihar Haiduk1, Kirill A Lyapichev2

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Summary
This summary is machine-generated.

B-lymphoblastic leukemia/lymphoma (B-ALL/LBL) can rarely manifest as skin lesions, even in adults. This case highlights the importance of considering B-ALL/LBL in atypical skin presentations, especially when common lymphoma markers are negative.

Keywords:
B-ALL/LBLLeukemia cutisSkin biopsy

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Area of Science:

  • Hematology
  • Dermatology
  • Oncology

Background:

  • B-lymphoblastic leukemia/lymphoma (B-ALL/LBL) typically affects children and young adults.
  • Skin involvement in B-ALL/LBL is uncommon.
  • Standard lymphoma markers (CD45, CD3, CD20) may be negative in B-ALL/LBL.

Purpose of the Study:

  • To report a rare case of adult-onset B-ALL/LBL presenting with skin lesions.
  • To emphasize the diagnostic challenges posed by atypical immunophenotypes in B-ALL/LBL.
  • To highlight the importance of comprehensive immunohistochemistry in diagnosing rare hematologic malignancies.

Main Methods:

  • Clinical presentation of multiple, tender skin lesions in a 56-year-old male.
  • Skin punch biopsy revealing extensive lymphoid infiltrates.
  • Immunohistochemistry panel including CD45, CD3, CD20, PAX5, TdT, CD10, CD34, CD79a, CD99, and others.
  • Peripheral blood and bone marrow biopsy for confirmation.

Main Results:

  • Histologic and immunophenotypic findings confirmed B-ALL/LBL.
  • Atypical lymphoid infiltrate was positive for PAX5, TdT, CD10, CD34, CD79a, and CD99.
  • The infiltrate was negative for CD45, CD3, CD20, CD4, CD8, Keratin, S100, CD56, CD138, and EMA.
  • Peripheral blood and bone marrow evaluations supported the diagnosis.

Conclusions:

  • B-ALL/LBL can present as skin lesions, even in adult patients.
  • Negative staining for common lymphoma markers (CD45, CD3, CD20) should not exclude B-ALL/LBL.
  • This case underscores the need for thorough diagnostic workup in unusual presentations of leukemia/lymphoma.