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Kanoje PK, Khullar G, Yadav AK, Saxena AK, Gupta DK. Generalized leukemia cutis as the initial manifestation of precursor B-cell acute lymphoblastic leukemia in a young male. Dermatol Ther 2020; 34:e14594. [PMID: 33247514 DOI: 10.1111/dth.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Priyanka Kamlesh Kanoje
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geeti Khullar
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Kumar Yadav
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashok Kumar Saxena
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Dipender Kumar Gupta
- Department of Clinical Hematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Thomas RM, Harrell JE, Rudnick E, Auerbach J, DeBenedetto A, Torres A, Motaparthi K. Leukemia cutis mimicking tumid lupus as the presenting sign in a case of mixed T/B-cell acute lymphoblastic leukemia. JAAD Case Rep 2020; 6:598-602. [PMID: 32685647 PMCID: PMC7355206 DOI: 10.1016/j.jdcr.2020.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Renee M Thomas
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Jane E Harrell
- University of Florida College of Medicine, Gainesville, Florida
| | - Eric Rudnick
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Jena Auerbach
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida
| | - Anna DeBenedetto
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Abel Torres
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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Ligon JA, Natarajan M, Shalabi H, Yates B, Bishop R, Bianchi D, Alencar A, Lionakis MS, Shah NN. Invasive fusariosis masquerading as extramedullary disease in rapidly progressive acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27732. [PMID: 30900813 PMCID: PMC8237328 DOI: 10.1002/pbc.27732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 11/11/2022]
Abstract
Invasive fusariosis (IF) most commonly occurs in patients with hematologic malignancies and severe neutropenia, particularly during concomitant corticosteroid use. Breakthrough infections can occur in high-risk patients despite Aspergillus-active antifungal prophylaxis. We describe a patient with rapid acute lymphoblastic leukemia (ALL) progression who presented with multifocal skin nodules thought to be choloromatous disease. These lesions were ultimately diagnosed as IF and the patient had two simultaneously active disease processes. This case highlights the importance of pathologic diagnosis of new skin lesions in ALL patients, even during leukemia progression, and demonstrates that IF can occur despite normal neutrophil counts and Aspergillus-active prophylaxis.
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Affiliation(s)
- John A. Ligon
- Department of Pediatric Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland,Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mukil Natarajan
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Haneen Shalabi
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bonnie Yates
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Rachel Bishop
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Bianchi
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Alvaro Alencar
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Michail S. Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nirali N. Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Pileri A, Papayannidis C, Messori S, Bacci F, Sagramoso CA, Martinelli G, Patrizi A. Leukemia cutis in a Ph+ ALL patient treated with ponatinib. GIORN ITAL DERMAT V 2018; 153:730-731. [PMID: 30246954 DOI: 10.23736/s0392-0488.17.05647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Pileri
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy - .,Unit of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy -
| | - Cristina Papayannidis
- Unit of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Messori
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Bacci
- Unit of Hematopathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlo A Sagramoso
- Unit of Hematopathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giovanni Martinelli
- Unit of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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Kantarcioglu B, Bekoz HS, Ogret YD, Cakir A, Kivanc D, Oguz FS, Sargin D. Isolated extramedullary cutaneous relapse despite concomitant severe graft-vs.-host disease and tissue chimerism analysis in a patient with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: A case report. Mol Clin Oncol 2017; 5:745-749. [PMID: 28105353 PMCID: PMC5228357 DOI: 10.3892/mco.2016.1052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option for patients with acute lymphoblastic leukemia (ALL). The curative potential of allo-HSCT for ALL is, in part, due to the graft-vs.-leukemia (GVL) effect, in addition to the intensive conditioning chemo-radiotherapy. However, relapse remains the major cause of treatment failure following allo-HSCT for ALL. In the allo-HSCT setting, testing for genetic markers of hematopoietic chimerism has become a part of the routine diagnostic program. Routine chimerism analysis is usually performed in peripheral blood or bone marrow; in fact, little is known about the value of tissue chimerism in patients with extramedullary relapse (EMR) after the allo-HSCT setting. The present study reports on, a case of a patient with ALL who experienced isolated cutaneous EMR despite ongoing graft-vs.-host disease (GVHD), and the results of peripheral blood and skin tissue chimerism studies using multiplex polymerase chain reaction (PCR) of short tandem repeats (STR-PCR). The present case demonstrates that, although complete remission and/or chimerism may be achieved in the bone marrow, chimerism achieved at the tissue level, and the subsequent GVL effect, may be limited, despite concomitant severe GVHD following allo-HSCT. Our tissue chimerism analysis results provide a good example of how skin tissue may be a ‘sanctuary’ site for effector cells of GVL, despite active GVHD and complete hematopoetic chimerism.
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Affiliation(s)
- Bulent Kantarcioglu
- Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Huseyin Saffet Bekoz
- Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Yeliz Duvarci Ogret
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul 34214, Turkey
| | - Asli Cakir
- Department of Pathology, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Demet Kivanc
- Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Fatma Savran Oguz
- Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul 34214, Turkey
| | - Deniz Sargin
- Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34214, Turkey
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