Abstract
The author describes paediatric case of relapsed acute lymphoblastic leukaemia (ALL) presented as aleukemic leukaemia cutis (ALC). A 2 year old child was admitted in tertiary oncology centre. He suffered from pre B cell ALL with absent Philadelphia chromosome. This patient received multiagent induction chemotherapy as per Berlin–Frankfurt–Munster (BFM) protocol for ALL. He achieved remission after 28 days of treatment. Subsequently he presented with multiple skin lesions in the form of multiple small erythematous violaceous macules, papules, plaques and nodules on face, chest and back regions. Histopathological examination of biopsy of skin revealed diffuse infiltration of tumor cells with prominent nucleoli, scant eosinophilic cytoplasm and numerous mitotic figures consistent with LC. Immunohistochemistry was positive for CD 10, CD 19, CD 22, CD 24, CD 79-a and TdT while negative for surface immunoglobulin. At the time of presentation his peripheral blood smear and bone marrow examination was negative for malignant cells. Sanctuary sites including central nervous system and testicles were not involved. So patient was diagnosed as ALC. He was managed as per BFM relapse protocol for ALL. Skin lesions disappeared completely after 2 weeks of treatment. Unfortunately patient developed bone marrow and testicular relapse after 2 months. He was given testicular radiotherapy and systemic chemotherapy for relapsed ALL. But his marrow was showing persistent activity and he expired after 4 months.
References
Su WP (1994) Clinical, histopathologic, and immunohistochemical correlations in leukemia cutis. Semin Dermatol 3:223–230
Wagner G, Fenchel K, Back W et al (2012) Leukemia cutis: epidemiology, clinical presentation, and differential diagnosis. J Dtsch Dermatol Ges 10:27–36
Cho-Vega JH, Medeiros J, Prieto VG et al (2008) Leukemia cutis. Am J Clin Pathol 129:130–142
Sander CA, Medeiros LJ, Abruzzo LV et al (1991) Lymphoblastic lymphoma presenting in cutaneous sites: a clinicopathologic analysis of six cases. J Am Acad Dermatol 25:1023–1031
Gaynon PS (2005) Childhood ALL and relapse. Br J Haematol 131(5):579–587
Rizzani C, Valsecchi MG et al (2004) outcome of very late relapse in children with ALL. Haematologica 89(4):427–434
Millot F, Robert A, Bertrand Y et al (1997) Cutaneous involvement in children with ALL or lymphoblastic lymphoma: the Children’s Leukemia Cooperative Group of the European Organization of Research and Treatment of Cancer (EORTC). Pediatrics 100:60–64
Stawiski MA (1978) Skin manifestations of leukemias and lymphomas. Cutis 21:814–818
Ratnam KV, Khor C, Su D (1994) Leukemia cutis. Dermatol Clin 12:419–429
Bakst RL, Tallman MS et al (2011) How I treat extramedullary acute myeloid leukemia. Blood 118(14):3785–3793
Lee JI, Park HJ, Oh ST et al (2009) A case of leukemia cutis at the site of a prior catheter insertion. Ann Dermatol 21:193–196
Najem N, Zadeh V, Badawi M et al (2011) Aleukemic leukemia cutis in a child pre ceding T-cell acute lymphoblastic leukemia. Pediatr Dermatol 28:535–537
Taniguchi S, Hamada T, Kutsuna H et al (1996) Lymphocytic aleukemic leukemia cutis. J Am Acad Dermatol 35:849–850
Kishimoto H, Furui Y, Nishioka K (2001) B-cell ALL with a leukemic leukemia cutis. Eur J Dermatol 11:151–152
Cochrane T, Milne JA (1974) A leukaemic acute lymphoblastic leukaemia presenting with cutaneous lesions. Br J Dermatol 91:587–589
Ali R, Ozan U, Ozkalemkas F et al (2006) Leukaemia cutis in T-cell acute lymphoblastic leukaemia. Cytopathology 17:158–161
Aneta S, Jakub L, Joanna Z et al (2014) Aleukemic leukemia cutis as a manifestation of acute lymphoblastic leukemia in a 13-year-old girl. Prog Med Sci 27(4):271–274
Leah H, Jayesh M, Jonathan C et al (2013) Recurrent aleukemic leukemia cutis in a patient with pre-B-cell acute lymphoblastic leukemia. J Clin Oncol 31:353–355
Kishimoto H, Furui Y, Nishioka K (2001) B-cell ALL with a leukemic leukemia cutis. Eur J Dermatol 11:151–152
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Joshi, K., Panchal, H., Parikh, S. et al. Aleukemic Leukemia Cutis Presenting as a Sole Sign of Relapsed Paediatric Acute Lymphoblastic Leukemia. Indian J Hematol Blood Transfus 32 (Suppl 1), 46–49 (2016). https://doi.org/10.1007/s12288-015-0597-z
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DOI: https://doi.org/10.1007/s12288-015-0597-z