Aleukemia Cutis: Clinicopathological Investigation of Two Cases

We describe two cases of acute myeloid leukemia (AML) who presented with cutaneous manifestations. Leukemia cutis is the cutaneous presentation of any type of leukemia and occurs in 10 - to 15 percent of patients with AML, but cutaneous infiltration of AML rarely precedes the involvement of the bone marrow or peripheral blood and is called as aleukaemia cutis. Our first case was a 46 year old man presented with facial skin thickening, a manifestation known as lionization and his initial clinical diagnosis was nonspecific allergic reaction. The second case presented with urticarial lesions of the trunk and extremities and the initial clinical and histomorphologic diagnosis was leukocytoclastic vasculitis. Histopathologic examination of the skin biopsy after bone marrow involvement showed diffuse infiltration of dermis with monotonous population of intermediate-sized mononuclear cells with blastic chromatin and promonocytic features. Leukemia cutis as the first manifestation of leukemia is very rare and could result in delayed diagnosis and adversely affect patient prognosis. The precedence of cutaneous manifestations resulted in a diagnosis delay of about one and three months in our first and second patient, respectively. Patient one died 269 days and patient two died 76 days after the initial AML diagnosis.

Keywords:

aleukemic cutaneous myeloid sarcoma , histiocytic , monocytic , aleukemia cutis , acute myeloid leukemia