Leukemia cutis as an initial presentation in a case of mixed phenotype acute leukemia: a double jeopardy

Abstract

Leukemia cutis (LC) is defined as infiltration of the skin by leukemic cells resulting in clinically recognizable cutaneous lesions. The lesions range from violaceous papules, plaques, nodules, blisters, maculopapular rash and as erythroderma. LC can precede or happen after the presentation of leukemia. Here, we report a case of Mixed phenotype Acute leukemia (MPAL) presenting as LC (erythematous & violaceous nodules) which is a rare as well as a grave combination as it carries a worse prognosis. Here, we present a case of MPAL which presented as Leukemia Cutis proven on biopsy. The paper discusses the importance of identifying LC both in a clinical and a pathological pretext as it is important to start the Chemotherapy for MPAL at the earliest for a better outcome.

Keywords: Leukemia cutis; mixed phenotype acute leukemia; nodules.

Figure 1

Clinical and histopathological images of leukemia cutis. A. Image shows Erythematous macules in the chest wall. B. Skin biopsy showing infiltration by blasts, H&E, 40×. C. Skin biopsy showing infiltration by blasts, H&E, 400× (Inset: CD34 IHC positivity).

Figure 2

Immunophenotyping (flow-cytometry) images of leukemia cutis. A. Immunophenotyping with flow cytometric analysis showing CD34 and CD19 positivity. B. Immunophenotyping with flow cytometric analysis showing MPO and CD79a positivity. C. Immunophenotyping with flow cytometric analysis showing CD64 and CD117 positivity.