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Subclinical chronic lymphocytic leukaemia associated with a 13q deletion presenting initially in the skin: apropos of a case
Author(s) -
Khandelwal Abha,
Seilstad Kay H.,
Magro Cynthia M.
Publication year - 2006
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/j.0303-6987.2006.00430.x
Subject(s) - lymphocytosis , medicine , pathology , chronic lymphocytic leukemia , subclinical infection , cd5 , context (archaeology) , lymphoma , leukemia , immunology , biology , paleontology
B‐cell chronic lymphocytic leukaemia (B‐CLL) represents a low‐grade B‐cell lymphoproliferative disease that is the most common leukaemia in adults. The neoplastic cell is an autoreactive CD5 CD23 B lymphocyte. B‐CLL may involve the skin, typically in the context of known disease. We present a case of subclinical B‐CLL presenting initially in the skin. Case Report: A 73‐year‐old male developed a lesion on his right cheek in April 2003 compatible with basal cell carcinoma. The re‐excision specimen contained a well‐differentiated atypical lymphocytic infiltrate consistent with B‐CLL along with residual carcinoma. Subsequent laboratory studies revealed peripheral blood lymphocytosis with smudge cells. A diagnosis was made of Rai stage 0 CLL. Chromosomal studies on peripheral blood showed a deletion at 13q14.3. Excision of a second primary skin carcinoma revealed a squamous cell carcinoma in association with B‐CLL that was identical to his previously diagnosed skin involvement. Conclusion: This case identifies a cutaneous presentation of subclinical B‐CLL. There are two prior reports describing B‐CLL presenting initially in the skin. In one case, the infiltrates were incidental on a re‐excision specimen. The second report suggests 16% of B‐CLL patients have cutaneous manifestations as the first sign of disease.