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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.
Insights
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.
Abstract:
Leukemia cutis (LC) is a manifestation of leukemia with infiltration of the dermis, epidermis, or subcutis by malignant leukocytes resulting in papules, plaques, nodules, or ulcers. It is usually associated with acute and chronic myeloid leukemia as well as T-cell acute lymphoblastic leukemia (T-ALL) but is very rare in patients with B-cell acute lymphoblastic leukemia (B-ALL). We report a case of a 58-year-old Hispanic male who presented with a non-healing leg ulcer of three months along with patches on the face, left arm, and bilateral legs with white blood cell (WBC) count of 50800/mm3 with 83% blasts, and flow cytometry findings of B-ALL. Punch biopsies from affected skin showed numerous dermal nodules composed of large atypical cells with open chromatin and prominent nucleoli. Immunohistochemical stains were consistent with B-ALL involving the skin and a diagnosis of LC was rendered. A high index of suspicion in relevant cases and prompt diagnosis is imperative to prevent any delays in appropriate therapy. Diagnosis in our case was aided by concurrent identification of B-ALL in the patient's peripheral blood. Since this information may not always be available, it is important to keep B-ALL in the differential any time there is a neoplastic infiltration of leukocytes in the dermis.
