title: Lymphocytic infiltrates and subclinical epithelial tumor extension in patients with chronic leukemia and solid-organ transplantation.
abstract: BACKGROUND
  Dense infiltrates in association with squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) in patients with underlying chronic lymphocytic leukemia (CLL) may complicate pathologic interpretation of histologic margins.
  
  
  OBJECTIVE
  The study was conducted to determine the frequency of identifying dense inflammatory infiltrates in frozen histologic sections during Mohs operation for BCC or SCC in patients with CLL and organ-transplant recipients, to characterize the infiltrate (reactive versus leukemic) in CLL, and to estimate the subclinical tumor extension in patients with CLL, transplant recipients, and control subjects undergoing Mohs procedure.
  
  
  METHODS
  Frozen sections of head and neck BCC and SCC obtained during Mohs procedures in patients with CLL, organ transplant recipients, and a control group were reviewed retrospectively. Biopsy specimens of CLL with dense infiltrates were assessed with immunohistochemical stains. Subclinical tumor extension (postoperative defect size minus preoperative tumor size) was evaluated in each group.
  
  
  RESULTS
  Dense infiltrates were found in tumors of 20 of 55 patients with CLL (36%), 1 of 8 transplant recipients (13%), and 1 of 105 controls (1%). In patients with CLL, 75% of the dense infiltrates were B-cell leukemic. Compared with controls, the mean subclinical tumor extension was larger in patients with CLL (P=0.029) and in transplant recipients (P=0.55).
  
  
  CONCLUSIONS
  Dense leukemic infiltrates associated with BCC or SCC in CLL may complicate pathologic interpretation of Mohs surgical histologic margins and may be associated with larger postoperative defects relative to preoperative clinical tumor appearance. In patients with CLL, as in transplant recipients, SCC seems more likely to develop than BCC.
authors.affiliation: Division of Dermatologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Mehrany
authors.forename: David R
authors.initials: DR
authors.lastname: Byrd
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
authors.forename: Roger H
authors.initials: RH
authors.lastname: Weenig
authors.forename: P Kim
authors.initials: PK
authors.lastname: Phillips
authors.forename: Tri H
authors.initials: TH
authors.lastname: Nguyen
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D017254:Leukemic Infiltration / Q000473:pathology*; D008297:Male; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery