title: CLL/SLL with initial presentation as a longstanding cutaneous plaque: a rare case.
abstract: While chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia in the western world, it uncommonly initially presents as a cutaneous lesion. When it does, it is often found incidentally in the context of another distinct lesion. We present a case of CLL/SLL that initially presented as a solitary nodular erythematous plaque on the left flank of a healthy 60-year-old man without lymphadenopathy or constitutional symptoms. The lesion had been present for many years, but had recently begun to grow and become pruritic and painful. Excisional biopsy revealed a large nodular aggregate of variably sized CD20(dim), CD5(+), CD23(+), BCL-2(+) atypical lymphocytes in the dermis without epidermotropism. The lymphocytes were negative for BCL-1/cyclinD1, BCL-6, and CD10, and no other background lesion was identified. This constellation of biopsy findings was consistent with CLL/SLL. This case emphasizes the potential for involvement by CLL/SLL in the cutaneous biopsies of otherwise asymptomatic patients.
authors.affiliation: Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Fulton
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Daisy
authors.initials: D
authors.lastname: Alapat
authors.affiliation: Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mabry
authors.affiliation: Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.|Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Shalin
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D008875:Middle Aged; D012878:Skin Neoplasms / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor
keywords: CLL/SLL; cutaneous lymphoma; flow cytometry; histopathology