Abstract

Involvement of the skin by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is uncommon and its coexistence with multiple dermatofibromas is extraordinarily rare in the reported literature. Herein we present a case of a 53-year-old female with no known relevant medical history who presented to her dermatologist with multiple dark nodules over her bilateral arms and legs which had been present for three years and had since grown in size. The two largest and most painful nodules, a 5mm on her left thigh and an 8mm on her left forearm, were excised, and histologic examination of each demonstrated features consistent with dermatofibromas. Incidentally, multiple lymphoid aggregates were appreciated at the superficial and deep peripheral aspects. These foci were composed of small and monotonous cells with minimal atypia. In order to further characterize the lesion, immunohistochemical studies were performed. The cells of interest demonstrated expression with CD20, BCL2, CD5, and CD23, and admixed T-cells were appreciated with CD3. Given these findings, a diagnosis of associated CLL/SLL was rendered. On follow-up, flow cytometry of the peripheral blood confirmed the presence of CLL, and FISH analysis was notable for trisomy 12. It is our aim to increase diagnostic awareness of such a rare initial presentation of this entity.