Track: Case Reports

Topic: Lymphoproliferative Disorders

Abstract:

Chronic lymphocytic leukemia (CLL)/Small lymphoblastic lymphoma (SLL) is the most common indolent lymphoma in the Western world. Although initial presentation of CLL/CLL as a cutaneous lesion is rare, we present a case of CLL/SLL that presented as a 3.0 cm firm, indurated plaque of the right nasal sidewall of an 89-year-old man without a known history of hematologic malignancy. On hematoxylin and eosin, shave biopsy revealed a dense diffuse atypical infiltrate of small monomorphous lymphocytic cells with scant cytoplasm and oval nuclei with slight nuclear irregularity, condensed chromatin, and indistinct nucleoli. Enlarged prolymphocytic cells and histiocytes were rare. No mitoses, enlarged centroblastic, or immunoblastic cells were seen. Immunohistochemical analysis demonstrated positivity for CD5, CD20, CD43, CD79a, and BCL-2, with weak and variable positivity for LEF1 in the lymphocytic infiltrate, and negativity for CD3, CD4, CD8, CD10, CD21, CD23, Cyclin D1, MUM1 and BCL-6. Complete blood count shows: leukocytosis 12.95 TH/cmm, relative lymphocytes 56.7% and absolute lymphocyte count of 7,400 TH/cmm. Fluorescence in situ hybridization analysis was negative for trisomies 3, 12, and 18; for BCL6, IGH, and MALT1 rearrangements; and for IGH::CCND1 (11;14), BIRC3::MALT1 (11;18), and IGH::MALT1 (14;18) fusions. The skin biopsy findings are consistent with CLL/SLL, highlighting the importance of correlation with laboratory and clinical findings in the differential diagnosis of cutaneous lesions. Although cutaneous involvement does not affect the prognosis of CLL/SLL, early detection is helpful to begin appropriate treatment.

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Ariel Velasquez-Evers, MD