Skin metastasis in patient with hairy cell leukemia: case report and review of literature

The reported case of Hairy cell leukemia (HCL) refers to a 47-year-old man with pancytopenia, splenomegaly, a month and a half history of dyspnea on mild effort and in common daily activities and a purplish-brown cutaneous node on the back of the left hand at the time of hospital admission. Bone marrow aspiration showed an infiltration by a lymphoproliferative malignancy and the following cytochemical studies on bone marrow sample led to diagnosis of HCL. The biopsy of the skin lesion revealed a infiltrate of medium and large-size cells in the dermis with the the same cytologic features of leukemic blasts appearing in the bone marrow, upon which the diagnosis of Leukemia cutis was established. The differential diagnosis of leukemia includes other neoplastic hematopoietic disorders, such as lymphoma, myelodysplastic syndromes, multiple myeloma, aplastic anemia, severe megaloblastic anemia, severe lymphocytosis, severe monocytosis, and bone marrow failure. In our case, the skin lesion was surgically removed and then left to heal by secondary intention due to the presence of bacterial infection by Staphylococcus aureus and Streptococcus pyogenes. The wound was finally medicated to total healing with Promogran®, an advanced dressings which consists of a sterile, freeze-dried matrix composed of collagen and oxidised regenerated cellulose. The importance of our case lies in the fact that cases with association of HCL with leukemia cutis are very rare, and furthermore that after the excision of the skin lesion of the left hand, the surgeons heal to let the wound close by secondary intention.

Leukaemic infiltration of the mandible in a young girl

BACKGROUND

This report presents a case of leukaemic infiltration of the mandible in a 10-year-old female of Sudanese extraction.

CASE REPORT

The patient was in remission from acute lymphoblastic leukaemia when she presented with pain localized to the alveolar ridge overlying the unerupted lower right second permanent molar. Two days later, she developed right inferior alveolar nerve paraesthesia. Radiographic imaging demonstrated cortical line absence around the developing lower right second and third permanent molars, and distal displacement of the lower right third molar. In addition, the cortical outline of the right inferior dental canal lacked clarity. Biopsy confirmed leukaemia recurrence demonstrating the Philadelphia chromosome. Tailored chemotherapy was commenced, and a bone marrow transplant was carried out 12 weeks later. At 6-month dental review, the patient remained exceptionally well with no bone pain and normal sensation in the right lower lip.

CONCLUSION

The importance of regular and long-term dental examination of patients with leukaemia is discussed.

A case of leukemia of the appendix presenting as acute appendicitis

A 71-year-old man was admitted to our hospital because of right lower abdominal pain. He was suspected of having acute appendicitis and soon after admission, appendectomy was performed. Macroscopically, the appendix was greatly swollen and reddened, but had no abscess. Microscopically, polymorphonuclear leukocytes were not found, but diffuse infiltration of atypical cells was observed. Examination of a bone marrow aspirate revealed 74% blasts that were peroxidase stain positive. We diagnosed acute myelogenous leukemia (FAB classification, M2). He received induction chemotherapy, but died 49 days after admission. Leukemic cell infiltration of the appendix is rare and acute appendicitis as the initial manifestation of leukemia is even rarer.

Chronic myelomonocytic leukemia revealed by uncontrollable hematuria

Nephrectomy was performed for uncontrollable unilateral hematuria in an apparently healthy 72-year-old man. The suburothelial connective tissue of the kidney was infiltrated by primitive myeloid cells with associated acute vasculitis and foci of extramedullary hematopoiesis. Subsequently, the patient was shown to have chronic myelomonocytic leukemia. Although renal involvement and vasculitis have been recorded previously in chronic myelomonocytic leukemia, this is the first occasion, to our knowledge, where their concurrence resulted in such a spectacular presentation.

Magnetic resonance imaging diagnosis of metastasis of chronic myelocytic leukemia to the uterus

We report a case of chronic myelocytic leukemia (CML) in which the initial manifestation of blastic crisis was massive genital bleeding. The bleeding was diagnosed as being caused by CML metastasis to the uterus on the basis of the magnetic resonance imaging findings.

Lumbar intervertebral disc involvement in chronic lymphocytic leukemia. A case report

STUDY DESIGN

Report of a patient with a rare location of a solid chronic lymphocytic leukemic mass of an intervertebral lumbar disc.

OBJECTIVES

To illustrate the previously undescribed discovertebral involvement of chronic lymphocytic leukemia and to discuss the diagnostic difficulties.

SUMMARY OF BACKGROUND DATA

Chronic lymphocytic leukemia primarily involves lymph nodes, spleen, liver, and bone marrow. Bone lesions are rare in chronic lymphocytic leukemia and usually consist of areas of osteopenia. Spinal involvement in chronic lymphocytic leukemia is rare, and only two cases of spinal cord compression attributable to an extradural solid mass composed of leukemic cells have been reported. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously.

METHODS

The clinical findings, radiographs, histology, treatment, and follow-up results are presented.

RESULTS

Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of the intervertebral disc L2-L3 with dura compression. Treatment consisted of radiotherapy followed by en bloc resection of vertebrae L2 and L3 stabilized with stackable cages and anterior fixation with Kaneda bars. Intervertebral disc infiltration with leukemic cells of B-cell origin was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treatment the patient was still in remission and fully mobilized.

CONCLUSIONS

Intervertebral disc involvement in cases of chronic lymphocytic leukemia is rare. Its presence should be considered in patients with back pain and neurologic symptoms who had been treated for this form of leukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.