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Wright WA, Salisbury J, Wright D, Rider T, Corbett T, Potter V, Krishnamurthy P, Basu T. A patient with widespread firm nontender nodules. JAAD Case Rep 2023; 37:68-70. [PMID: 37492427 PMCID: PMC10363658 DOI: 10.1016/j.jdcr.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- William A. Wright
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jon Salisbury
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - David Wright
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex
| | - Tom Rider
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex
| | - Timothy Corbett
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex
| | - Victoria Potter
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Tanya Basu
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Osmola M, Gierej B, Kłosowicz A, Waszczuk-Gajda A, Basak GW, Jędrzejczak WW, Jurczyszyn A, Ziarkiewicz-Wróblewska B. Leukaemia cutis for clinicians, a literature review. Postepy Dermatol Alergol 2021; 38:359-365. [PMID: 34377113 PMCID: PMC8330858 DOI: 10.5114/ada.2021.107923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022] Open
Abstract
Leukaemia cutis (LC) describes infiltration of the skin by leukaemia cells, resulting in clinically identifiable cutaneous lesions. LC has a wide range of clinical manifestations, which can make it difficult to distinguish LC from other skin changes. In a group of patients, LC can be the first manifestation of leukaemia, therefore skin biopsy is crucial for the diagnosis. In this mini review, we discuss various types of leukaemia most frequently represented in leukaemia cutis, in both children and adults and skin changes in multiple myeloma, focusing on the clinical presentation of LC and prognosis in patients.
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Affiliation(s)
- Małgorzata Osmola
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Beata Gierej
- Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Kłosowicz
- Department of Dermatology, University Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz W. Basak
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław W. Jędrzejczak
- Department of Haematology, Oncology and Internal Diseases, University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - Artur Jurczyszyn
- Department of Haematology, Jagiellonian University Medical College, Krakow, Poland
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Calado R, Relvas M, Morgado F, Cardoso JC, Tellechea O. Specific cutaneous infiltrates in patients with haematological neoplasms: a retrospective study with 49 patients. Australas J Dermatol 2021; 62:e228-e235. [PMID: 33403659 DOI: 10.1111/ajd.13533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Haematological neoplasms account for around 9% of all cancers, and they are recognised as an important cause of skin infiltration. However, studies analysing cutaneous metastasis of haematological neoplasms are scarce. We describe the clinical spectrum and outcomes of specific cutaneous manifestations of leukaemias, lymphomas, multiple myeloma (MM), and blastic plasmacytoid dendritic cell neoplasm (BPDN) and make a review of the literature. METHODS Data from 49 patients diagnosed with secondary cutaneous infiltration of systemic haematological neoplasms over the last 10 years in a tertiary dermatology centre were retrospectively collected, and clinical-evolutive features were analysed. RESULTS Most cases were lymphoma (44.9%, n = 22), followed by leukaemia cutis (38.8%, n = 19), secondary plasmacytoma (10.2%, n = 5) and BPDN (6.1%, n = 3). Nodules were the predominant type of lesion, and most patients presented with multiple (≥3) lesions. In 51% (n = 25) of cases, cutaneous infiltration was detected before the diagnosis of the underlying malignancy. The patients in diverse nosological groups did not differ in terms of survival (P = 0.052). CONCLUSIONS We recognise the clinical heterogeneity of specific cutaneous infiltrates. The high proportion of cases in which skin involvement was key to the diagnosis of systemic malignancy emphasises the role of the dermatologist in recognising and correctly managing these patients.
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Affiliation(s)
- Rebeca Calado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Relvas
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Francisca Morgado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - José Carlos Cardoso
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Oscar Tellechea
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
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Bardou MLD, Rivitti-Machado MC, Michalany NS, de Jesus AA, Goldbach-Mansky R, Barros JCR, Terreri MTDSELRA, Grumach AS. Neutrophilic dermatosis: a new skin manifestation and novel pathogenic variant in a rare autoinflammatory disease. Australas J Dermatol 2020; 62:e276-e279. [PMID: 33332575 DOI: 10.1111/ajd.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
Sideroblastic anaemia, B-cell immunodeficiency, periodic fever and developmental delay (SIFD) is caused by mutations of TRNT1, an enzyme essential for mitochondrial protein synthesis, and has been reported in 23 cases. A 6-month-old girl was evaluated with recurrent fever, failure to thrive, skin lesions and anaemia. She received blood transfusions and empirical antibiotics. Skin lesions, previously interpreted as insect bites, consisted of numerous firm asymptomatic erythematous papules and nodules, distributed over trunk and limbs. Skin histopathology revealed an intense dermal neutrophilic infiltrate extending to the subcutaneous, with numerous atypical myeloid cells, requiring the diagnosis of leukaemia cutis, to be ruled out. Over the follow-up, she developed herpetic stomatitis, tonsillitis, lobar pneumonia and Metapneumovirus tracheitis, and also deeper skin lesions, resembling panniculitis. Hypogammaglobulinaemia was diagnosed. An autoinflammatory disease was confirmed by whole exome sequencing: heterozygous mutations for TRNT1 NM_182916 c.495_498del, p.F167Tfs * 9 and TRNT1 NM_182916 c.1246A>G, p.K416E. The patient has been treated with subcutaneous immunoglobulin and etanercept. She presented with developmental delay and short stature for age. The fever, anaemia, skin neutrophilic infiltration and the inflammatory parameters improved. We describe a novel mutation in SIFD and the first to present skin manifestations, namely neutrophilic dermal and hypodermal infiltration.
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Affiliation(s)
| | | | - Nilceo Schwery Michalany
- Collaborating Professor of Pathology Department, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Adriana Almeida de Jesus
- Translational Autoinflammatory Disease Studies Unit, National Institute of Health, Bethesda, MD, USA
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Disease Studies Unit, National Institute of Health, Bethesda, MD, USA
| | | | | | - Anete Sevciovic Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario Saude ABC, Sao Paulo, Brazil
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Bonometti A, Gliozzo J, Moltrasio C, Bagnoli F, Berti E. Cutaneous-group histiocytoses associated with myeloid malignancies: A systematic review of 102 cases. Australas J Dermatol 2020; 62:e162-e169. [PMID: 33125722 DOI: 10.1111/ajd.13491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Histiocytoses are haematological disorders of bone marrow origin that share many biological and clinical features with haematological neoplasms. The association between histiocytoses of the cutaneous-group and myeloid malignancies is a poorly investigated topic of high biological and clinical impact. METHODS We performed a systematic review of the scientific literature, compliant with PRISMA guidelines, to unravel the clinical and pathological features of this intriguing association. FINDINGS We gathered and analysed 102 patients. Most were children with generalised cutaneous eruptions and displayed risk organ involvement (i.e. bone marrow, spleen, liver). Interestingly, all these features are uncommonly encountered in C-group histiocytosis not associated with haematological neoplasms. CONCLUSIONS Our review shows that generalised eruptions and risk organ involvement in cutaneous-group histiocytosis should raise a suspicion for a concomitant myeloid neoplasm both in children and in adults and warrant further investigations. A rapid recognition of this association is required to start a prompt and effective therapeutic management given the aggressive behaviour of the associated myeloid neoplasm in most instances.
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Affiliation(s)
- Arturo Bonometti
- Unit of Anatomic Pathology, Department of Molecular Medicine, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jessica Gliozzo
- Department of Dermatology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Unit of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Moltrasio
- Department of Dermatology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Bagnoli
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Emilio Berti
- Department of Dermatology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
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Richarz NA, Puig L, Pérez N, Cuadra-Urteaga J, Elez E, Fernández-Figueras MT. Vemurafenib-induced histiocytoid neutrophilic panniculitis simulating myeloid leukaemia cutis. Cancer Biol Ther 2018; 20:237-239. [PMID: 30426827 DOI: 10.1080/15384047.2018.1529113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neutrophilic panniculitis is an infrequent but characteristic adverse event under therapy with BRAF inhibitors (BRAFi). Since the approval of vemurafenib for treatment of metastatic melanoma in 2011, only two cases of neutrophilic panniculitis in malignancies other than melanoma have been published. Histiocytoid infiltrates of immature neutrophils resembling histiocytes or myelocytes have been reported in Sweet's syndrome and rarely in other neutrophilic dermatoses. We describe a novel variant of neutrophilic panniculitis with histiocytoid myeloid cells in an early lesion from a patient treated with vemurafenib in combination with an anti-EGFR (epidermal growth factor receptor) agent for metastatic colon carcinoma, three weeks after initiation of therapy. Recognizing this variant of panniculitis associated to BRAFi can avoid misinterpretation of the atypical subcutaneous infiltrate as myeloid leukaemia cutis.
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Affiliation(s)
- Nina Anika Richarz
- a Department of Dermatology , Hospital Universitari Germans Trias i Pujol , Badalona , Barcelona, Spain.,b Universitat Autónoma de Barcelona (UAB) , Barcelona , Spain
| | - Luis Puig
- b Universitat Autónoma de Barcelona (UAB) , Barcelona , Spain.,c Department of Dermatology , Hospital Santa Creu i Sant Pau , Barcelona , Spain
| | - Noelia Pérez
- d Department of Pathology , Hospital Universitari General de Catalunya-QuirónSalud, Universitat Internacional de Catalunya , Sant Cugat del Vallés, Barcelona , Spain
| | - Jose Cuadra-Urteaga
- b Universitat Autónoma de Barcelona (UAB) , Barcelona , Spain.,e Department of Medical Oncology , IOB Institute of Oncology, Hospital Quirón , Barcelona , Spain
| | - Elena Elez
- b Universitat Autónoma de Barcelona (UAB) , Barcelona , Spain.,e Department of Medical Oncology , IOB Institute of Oncology, Hospital Quirón , Barcelona , Spain.,f Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain.,g Department of Medical Oncology , Vall D'Hebron University Hospital , Barcelona , Spain
| | - Maria Teresa Fernández-Figueras
- d Department of Pathology , Hospital Universitari General de Catalunya-QuirónSalud, Universitat Internacional de Catalunya , Sant Cugat del Vallés, Barcelona , Spain
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Pamuk GE, Ak R, Tasci M, Harmandar F, Demir M, Arican O. Clinical characteristics of haematological malignancy patients diagnosed with leukaemia cutis: Experience of a single centre. Australas J Dermatol 2014; 56:116-9. [PMID: 25367408 DOI: 10.1111/ajd.12193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the clinical characteristics of patients with haematological malignancies at our centre who were diagnosed with leukaemia cutis (LC). In addition, we describe the spectrum of other skin lesions, including, secondary skin malignancies and nonspecific benign skin lesions in haematological malignancy patients. METHODS We defined 58 skin lesions that developed in 54 inpatients hospitalised in the Department of Haematology, Trakya University Medical Faculty, Turkey. All skin lesions that developed in inpatients between 2006 and 2012 had been evaluated by a dermatologist. The patients' clinical features, skin biopsy results and therapies were obtained from hospital files. The diagnosis of LC was based on clinical features and histopathological examinations of the skin biopsy. RESULTS There were 11 patients with LC. Six (54.5%) had acute myeloblastic leukaemia. In nine patients (82%), LC was present at the initial presentation. Secondary skin malignancy was detected in 11 patients (five basal cell carcinoma, four Kaposi's sarcoma, one squamous cell carcinoma, one malignant melanoma); and malignancy was present in two patients (18%) at the initial presentation. Nonspecific benign skin lesions, the most frequent of which were drug eruptions, were determined in 32 of our patients. LC had a significantly higher likelihood of being present at initial presentation than other skin lesions (P < 0.01). The median survival in LC patients was quite short (4.5 months). CONCLUSIONS LC was usually diagnosed at the initial presentation of the patient or during the early course of the disease. Having LC was a poor prognostic factor.
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Affiliation(s)
- Gulsum Emel Pamuk
- Division of Haematology, Trakya University Medical Faculty, Edirne, Turkey
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