title: Aleukemic Leukemia Cutis Presenting as a Sole Sign of Relapsed Paediatric Acute Lymphoblastic Leukemia.
abstract: The author describes paediatric case of relapsed acute lymphoblastic leukaemia (ALL) presented as aleukemic leukaemia cutis (ALC). A 2 year old child was admitted in tertiary oncology centre. He suffered from pre B cell ALL with absent Philadelphia chromosome. This patient received multiagent induction chemotherapy as per Berlin-Frankfurt-Munster (BFM) protocol for ALL. He achieved remission after 28 days of treatment. Subsequently he presented with multiple skin lesions in the form of multiple small erythematous violaceous macules, papules, plaques and nodules on face, chest and back regions. Histopathological examination of biopsy of skin revealed diffuse infiltration of tumor cells with prominent nucleoli, scant eosinophilic cytoplasm and numerous mitotic figures consistent with LC. Immunohistochemistry was positive for CD 10, CD 19, CD 22, CD 24, CD 79-a and TdT while negative for surface immunoglobulin. At the time of presentation his peripheral blood smear and bone marrow examination was negative for malignant cells. Sanctuary sites including central nervous system and testicles were not involved. So patient was diagnosed as ALC. He was managed as per BFM relapse protocol for ALL. Skin lesions disappeared completely after 2 weeks of treatment. Unfortunately patient developed bone marrow and testicular relapse after 2 months. He was given testicular radiotherapy and systemic chemotherapy for relapsed ALL. But his marrow was showing persistent activity and he expired after 4 months.
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India ; 1, Akshar, Parth Housing Society, Sai Nagar, Near R.T.O. Corner, Dindori Road, Nashik, Maharashtra 422004 India.
authors.forename: Kshitij
authors.identifier: 0000-0001-7912-9840
authors.initials: K
authors.lastname: Joshi
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Panchal
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Sonia
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Gaurang
authors.initials: G
authors.lastname: Modi
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Talele
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Asha
authors.initials: A
authors.lastname: Anand
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Urmila
authors.initials: U
authors.lastname: Uparkar
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Centre (GCRI), Ahmadabad, Gujarat India.
authors.forename: Itesh
authors.initials: I
authors.lastname: Khatawani
keywords: Aleukemic leukaemia cutis; Leukaemia cutis; Paediatric case; Pre B cell ALL; Relapsed acute lymphoblastic leukaemia