Secondary cutaneous infiltration in B cell chronic lymphocytic leukemia.
We describe a patient presenting with B cell chronic lymphocytic leukemia (B-CLL) who subsequently developed cutaneous infiltrates. Specimens of the blood, bone marrow and cutaneous infiltrations all showed the same heavy-chain gene rearrangement. Following failure of conventional chemotherapy, and in view of the similarity of the disease to cutaneous T cell lymphoma, interferon-alpha therapy was employed with satisfactory results. Introduction of this cytokine to the therapeutic modalities for secondary cutaneous B-CLL would hopefully change the poor outcome of this entity, or at least could produce a better quality of life. Loss of histidine decarboxylase activity in the infiltrating cells - in contrast to circulating lymphocytes - may be associated with the transformation of B-CLL to a more aggressive infiltrative form, offering a possible explanation for tissue invasiveness. The changing character of the disease raises the possibility of a second mutational event in the course of B-CLL.
Várkonyi
J
J
3rd Department of Internal Medicine, Semmelweis University of Medicine, Budapest, Hungary. quittner@OSI.hu
Zalatnai
A
A
Timár
J
J
Matolcsi
A
A
Falus
A
A
Bencsáth
M
M
László
V
V
Pócsik
E
E
Kotlán
B
B
Császár
A
A
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002699:Chlorambucil / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006640:Histidine Decarboxylase / Q000172:deficiency; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology*; D017254:Leukemic Infiltration; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000172:deficiency; D011239:Prednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011994:Recombinant Proteins; D016879:Salvage Therapy; D012867:Skin / Q000473:pathology*; D014750:Vincristine / Q000008:administration & dosage
D007155:Immunologic Factors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D009363:Neoplasm Proteins; D011994:Recombinant Proteins; D002699:Chlorambucil; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D006640:Histidine Decarboxylase; D011241:Prednisone