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Chronic myelomonocytic leukemia masquerading as cutaneous indeterminate dendritic cell tumor: Expanding the spectrum of skin lesions in chronic myelomonocytic leukemia
Author(s) -
Loghavi Sanam,
Curry Jonathan L.,
GarciaManero Guillermo,
Patel Keyur P.,
Xu Jie,
Khoury Joseph D.,
TorresCabala Carlos A.,
Nagarajan Priyadharsini,
Aung Phyu P.,
Gibson Bernard R.,
Goodwin Brandon P.,
Kelly Brent C.,
Korivi Brinda R.,
Medeiros L. Jeffrey,
Prieto Victor G.,
Kantarjian Hagop M.,
BuesoRamos Carlos E.,
Tetzlaff Michael T.
Publication year - 2017
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13039
Subject(s) - chronic myelomonocytic leukemia , medicine , pathology , immunophenotyping , monocytosis , leukemia , myelodysplastic syndromes , histiocyte , myeloid , bone marrow , immunology , antigen
Chronic myelomonocytic leukemia (CMML) is a hematopoietic stem cell neoplasm exhibiting both myelodysplastic and myeloproliferative features. Cutaneous involvement by CMML is critical to recognize as it typically is a harbinger of disease progression and an increased incidence of transformation to acute myeloid leukemia. Cutaneous lesions of CMML exhibit heterogeneous histopathologic features that can be challenging to recognize as CMML. We describe a 67‐year‐old man with a 3‐year history of CMML who had been managed on single‐agent azacitidine with stable disease before developing splenomegaly and acute onset skin lesions. Examination of these skin lesions revealed a dense infiltrate of histiocytic cells morphologically resembling Langerhans type cells (lacking frank histopathologic atypia), and with the immunophenotype of an indeterminate cell histiocytosis (S100+ CD1a+ and langerin−). Given the history of CMML, next‐generation sequencing studies were performed on the skin biopsy. These revealed a KRAS (p.G12R) mutation identical to that seen in the CMML 3 years prior, establishing a clonal relationship between the 2 processes. This case expands the spectrum for and underscores the protean nature of cutaneous involvement by CMML and underscores the importance of heightened vigilance when evaluating skin lesions of CMML patients.