Unusual cutaneous manifestations of B-cell chronic lymphocytic leukemia.
BACKGROUND
B-cell chronic lymphocytic leukemia (B-CLL) is a low-grade lymphoproliferative disorder with characteristic histomorphologic features and an identifiable immunophenotype. The skin can be involved in the context of known disease, but cutaneous signs are rarely the presenting findings.


OBJECTIVE
Evaluation of unusual clinical cutaneous presentations of B-CLL.


METHODS
We conducted a retrospective case series analysis of 3 patients with unusual cutaneous clinicopathologic presentations of B-cell chronic lymphocytic leukemia, including erythematous plaques, angiomatosis/telangiectasia, and erosive skin changes, respectively, without a previous clinical history of chronic lymphocytic lymphoma. Main outcome measures were clinical cutaneous presentations and histopathologic results in the diagnosis of underlying disease.


RESULTS
In the 3 cases, lesion locations were the lower cheek, lower extremity, and penis (groin region). Histomorphologic testing showed mild to dense perivascular and periadnexal lymphoid aggregates throughout the dermis and extending into the panniculus, consistent with B-CLL. The diagnosis was confirmed with immunohistochemical studies that showed coexpression of CD5 and CD20 in the neoplastic lymphocytic infiltrate.


CONCLUSIONS
None.


CONCLUSIONS
Cutaneous manifestations are an uncommon presentation of subclinical B-CLL. Cutaneous changes were the presenting features of underlying lymphoma in all 3 cases, highlighting the importance of maintaining a high index of suspicion for a lymphoproliferative process in cases with unusual or atypical clinicopathologic features. Additional investigations into the behavior of B-CLL in the skin may elucidate further the evolution of cutaneous lesions in this disease.
Plaza
Jose Antonio
JA
Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Comfere
Nneka I
NI
Gibson
Lawrence E
LE
Colgan
Michael
M
Davis
Dawn Marie R
DM
Pittelkow
Mark R
MR
Colgan
Joseph P
JP
D000368:Aged; D000369:Aged, 80 and over; D018951:Antigens, CD20 / Q000032:analysis; D018956:CD5 Antigens / Q000032:analysis; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology; D013684:Telangiectasis / Q000209:etiology
D018951:Antigens, CD20; D018956:CD5 Antigens