A case of congenital leukemia cutis

Abstract

Congenital leukemia is a rare disease that develops from birth to 6 weeks of life. Leukemia cutis involves cutaneous infiltration by leukemic cells and is an unusual manifestation of leukemia, and has been documented in 25~30% of patients with congenital leukemia. The authors report a case of congenital leukemia cutis. A newborn male presented with widespread firm dusky red papules and nodules on almost his entire body surface. Skin biopsy specimens confirmed the presence of leukemic infiltrations, and bone marrow cytology was consistent with acute myeloid leukemia of the FAB M5 type.

Keywords: Acute myeloid leukemia; Congenital leukemia; Leukemia cutis.

Fig. 1

(A) Multiple scattered dusky red papules and nodules were distributed over the entire body. (B) Diffuse purpuric macules and ecchymoses predominated on scalp, face, and neck.

Fig. 2

(A) Biopsy of a skin nodule on the right arm showing dense, diffuse, and atypical infiltration of leukemic cells into dermis and subcutaneous fat (Hematoxylin-eosin, ×100). (B) The majority of infiltrating cells were large pleomorphic cells with a round to oval nucleus with one or more discrete nuclei and abundant pale cytoplasm (Hematoxylin-eosin, ×400). (C) Leukemic cells stained positively for leukocyte common antigen (Immunohistochemical staining, ×100).

Fig. 3

(A) Peripheral blood smear showing markedly elevated monoblast and promonocyte numbers. (B), (C) Bone marrow aspiration showing promonocytes and monocytes containing azurophilic granules. (D) Bone marrow biopsy finding showing that the marrow space was packed with leukemic blasts and immature monocytes. (E), (F) The peripheral blood smear was positive for nonspecific esterase (NSE) and neutrophil activating factor (NaF).