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Leukemia Cutis


Presentation

  • Our patient died 5 weeks following initial presentation.[mdedge.com]
  • The section Cases presents brief case reports that convey clear, practical lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems.[cmaj.ca]
  • The authors present a unique case of a patient with APL who developed LC that clinically mimicked a disseminated herpes zoster infection. This is only the second reported case of LC as the presenting sign of APL.[jcadonline.com]
  • Case Presentation: A 49‐year‐old man presented with a diffuse, nontender, nonpruritic papular exanthem. He stated that it started on the chest and spread to his back and extremities.[shmabstracts.com]
  • Leukemia cutis is especially rare as the presenting symptom of leukemia and is associated with a poor prognosis.[escholarship.org]
Sepsis
  • A bone marrow transplant was performed, which was complicated by graft rejection and neutropaenic sepsis. The patient died 11 months after the initial diagnosis.[medicaljournals.se]
  • He was then transferred to hospice care and succumbed to his underlying disease and sepsis. The patient died at day 75 post-transplant, 25 days after his diagnosis of leukemia cutis.[cureus.com]
Refractory Anemia
  • Mijovic A, Novak A, Medenica L: Sweet’s syndrome associated with inversion of chromosome 3q in a patient with refractory anemia. Eur J Haematol 1992;49:156–157.[karger.com]
Intravenous Administration
  • Specifically, cytarabine (100–200 mg/m 2 ) typically is continuously administered intravenously for 7 days combined with intravenous administration of either daunorubicin (60–90 mg/m 2 ) or idarubicin (12 mg/m 2 ) on days 1, 2, and 3.[mdedge.com]
Respiratory Distress
  • Prior to initiation of salvage chemotherapy, the patient developed acute respiratory distress. Despite advanced cardiac life support, he could not be resuscitated.[shmabstracts.com]
  • The baby presented a mild respiratory distress with oxygen requirement in delivery room, hepatomegaly, a systolic murmur and no dysmorphic features.[jcnonweb.com]
Sore Throat
  • Case report A 53-year-old male was referred to Konkuk University Chungju Hospital (Chungju, Korea) for generalized cutaneous nodules on the face, anterior chest wall and legs ( Fig. 1 ), as well as a sore throat.[spandidos-publications.com]
Abdominal Pain
  • There was no history of fever with chills, weight loss, joint pains, hematuria, abdominal pain, or any other major medical or surgical illness in the past. Family history and personal history were not significant.[jahjournal.org]
Excoriation
  • This photograph shows linear areas, which are more violaceous in color, likely due to trauma to the area, such as excoriation, which results in hemorrhage into the skin.[emedicine.medscape.com]
Photosensitivity
  • There was no history of drug allergy, joint pains, chronic cough, fever, weight loss, hemoptysis, hematuria, photosensitivity, or any major medical or surgical illness in the past. Family and personal history were not significant.[jahjournal.org]

Workup

  • The traditional backbone of initial workup of AL, of acute leukemia, is composed of ctyomorphology, cytochemistry, immunophenotyping, and molecular cytogenetics. These techniques are the backbone of the initial diagnostic workup of acute leukemia.[ivoox.com]
  • If the patient develops high unrelenting fevers, especially during the course of treatment, an infectious workup is necessary as these patients are immunocompromised and prone to infections.[ncbi.nlm.nih.gov]
  • Clinical Testing and Workup Laboratory tests will include a complete blood count and a peripheral blood smear.[rarediseases.org]
Treponema Pallidum
  • Maternal serology, including TORCH, hepatitis B surface antigen, hepatitis C virus, venereal disease research laboratory and treponema pallidum hemagglutination assay, was negative.[jcnonweb.com]
Liver Biopsy
  • Liver magnetic resonance imaging (MRI) revealed a 6-cm mass in hepatic segments 4 and 8, and a liver biopsy demonstrated that hepatocellular carcinoma cells and immature blast cells coexisted.[spandidos-publications.com]

Treatment

  • Consequently, LC vanished after these treatments 15.[bmrat.org]
  • “Identifying a cohort of patients who may benefit from more intensive treatment is clinically relevant. However, having more intensive therapy may not necessarily improve treatment outcomes,” he cautioned.[cancernetwork.com]
  • Therapy-related acute myeloid leukaemia (t-AML) is a complication following exposure to cytotoxic agents used in the treatment of various primary malignancies (1).[medicaljournals.se]
  • Treatment / Management Treatment of leukemia cutis points toward addressing underlying leukemia using aggressive systemic chemotherapy. Systemic chemotherapy for leukemia depends on cancer subtype.[ncbi.nlm.nih.gov]
  • Only 24 patients with APL have been reported to have developed LC.[22–26] Interestingly, in all of these cases, the rash appeared to be induced by treatment with ATRA.[22–26] ATRA treatment is associated with an increased incidence of extramedullary disease[jcadonline.com]

Prognosis

  • […] with worse prognosis Spontaneous regression of LC without treatment has been observed Prognosis in CLL patients is good Exception of blastic transformation (Richter syndrome) is associated with poor prognosis MICROSCOPIC PATHOLOGY General Histologic[basicmedicalkey.com]
  • A diagnosis of leukemia cutis generally portends a poor prognosis and strongly correlates with additional sites of extramedullary involvement.[ncbi.nlm.nih.gov]
  • Previous reports have suggested poor prognosis for patients with LC, but these reports have largely consisted of descriptive studies with a limited number of patients.[jamanetwork.com]
  • Leukemia cutis is especially rare as the presenting symptom of leukemia and is associated with a poor prognosis.[escholarship.org]
  • Because it correlates with sites of additional extramedullary involvement, it typically portends a poor prognosis.[mdedge.com]

Etiology

  • Both genetic and environmental components are involved in the etiology of any leukemia and are responsible for maturation arrest and clonal expansion of precursor cells.[ncbi.nlm.nih.gov]
  • ) Leukemia cutis commonly used to describe lymphocytic leukemias involving skin Designated by precursor B- or T-cell lineage and chronic lymphocytic leukemia “Myeloid sarcoma” is preferred term when leukemic cells are of myeloid or monocytic lineage ETIOLOGY[basicmedicalkey.com]
  • Depending on the lesion’s appearance, the differential diagnoses can include lymphoma, drug eruptions, infectious etiologies, sarcoidosis, metastases from other malignancies, and blistering dermatoses.[mdedge.com]
  • Bacterial, fungal, and mycobacterial cultures should also be obtained to evaluate for possible infectious etiology [9]. Our patient’s lesions were a cutaneous manifestation of his underlying plasma cell leukemia.[cureus.com]
  • […] suggesting that chemotactic mechanisms may be involved. [12] Other factors associated with cutaneous involvement include aneuploidy of chromosome 8, acute myeloid leukemia with monocytic differentiation, and involvement of other extramedullary sites. [2] Etiology[emedicine.medscape.com]

Epidemiology

  • Leukemia cutis - epidemiology, clinical presentation,and differential diagnoses. J Dtsch Dermatol Ges. 2012;10:27-36. [ Links ] 15 Lee E, Park HJ, Cho BK, Lee JY, Lee S. Leukemia cutis as early relapse of T-cell acute lymphoblastic leukemia.[scielo.br]
  • View Article : Google Scholar : PubMed/NCBI 4 El-Serag HB and Rudolph KL: Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 132:2557–2576. 2007.[spandidos-publications.com]
  • ., Sweet syndrome, psoriasis) CLINICAL ISSUES Epidemiology Incidence Acute monocytic, myelomonocytic, and T-cell leukemias show highest incidence of leukemia cutis LC can be observed in all forms of acute myeloid leukemia (AML) Occurs in 10-15% of patients[basicmedicalkey.com]
  • Leukemia cutis - epidemiology, clinical presentation, and differential diagnoses. J Dtsch Dermatol Ges. 2012 Jan; 10 (1):27-36. [ PubMed : 22115500 ] 11. Paydaş S, Zorludemir S. Leukaemia cutis and leukaemic vasculitis. Br. J.[ncbi.nlm.nih.gov]
  • (This is an excellent recent review of the clinical manifestations, epidemiology, and histopathology. It discusses and compares the histopathology and immunophenotypes of several types of LC. There are several clinical and histologic photographs.)[dermatologyadvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of leukemia cutis involves the migration of leukemic cells into the skin.[ncbi.nlm.nih.gov]
  • Pathophysiology All types of leukemia result from the abnormal development of leukocytes in the bone marrow.[emedicine.medscape.com]
  • In the latter, a drastic change in chemotherapy regimen will be needed. [11] LC is often associated with many other sites of extensive involvement, and generally a very poor prognosis has been noted. [12], [13], [14], [15] The pathophysiology and mechanism[ijmpo.org]
  • […] leukemia in the peripheral blood and/or bone marrow.[ 4 ] There are some gene abnormalities associated with leukemia cutis, including numerical abnormalities of chromosome 8, translocation (8; 21) (q22; q22), and inversion (16) (p13; q22).[ 2, 5 ] The pathophysiology[ncbi.nlm.nih.gov]
  • […] molecule-1 and lymphocyte function-associated antigen-1 has been hypothesized to be involved. 113 Future studies Establishing the underlying molecular basis for the migration of leukemia cells to specific sites is critical to understanding the specific pathophysiology[bloodjournal.org]

Prevention

  • Salvage chemotherapy has been applied successfully to prevent the development of LC in the patient's skin. Introduction Leukemia cutis (LC) is known as a general term for skin lesions caused by leukemia 1.[bmrat.org]
  • Antimicrobials Most patients will also receive antimicrobials as a preventative measure against infections after these skin lesions are found.[leukaemiacare.org.uk]
  • […] skin relapse. 8 It has been suggested that aggressive chemotherapy should continue even after remission to prevent further relapse. 2 The prognosis of leukemia cutis tends to be grave, with 88% of patients dying within one year of diagnosis. 1,3,5 Another[the-dermatologist.com]
  • Therefore, new research directions are crucial to predict, prevent and combat virus diseases. This Special Issue will include manuscripts on different aspects of virus diseases in both humans and animals.[mdpi.com]
  • Chemotherapy can reduce the number of cancerous cells in the body and prevent new cells from forming.[rarediseases.org]

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