Spontaneous Regression Of Aleukemia Congenital Leukemia Cutis
Landers, M. C., Malempati, S., Tilford, D., Gatter, K., White, C., & Schroeder, T. L. (2005). spontaneous regression of aleukemia congenital leukemia cutis. Pediatric dermatology, 22(1), 26–30. https://doi.org/10.1111/j.1525-1470.2005.22106.x
View Original Source →Abstract
A full-term 2-week-old boy was referred to the pediatric dermatology clinic with numerous blue to violaceous nodules present since birth. TORCH titers (against toxoplasmosis, cytomegalovirus, herpes simplex virus, rubella, and syphilis) were negative. Complete blood count and peripheral smear were normal. A skin biopsy specimen showed an atypical cellular infiltrate suspicious for leukemia or lymphoma. A bone marrow biopsy specimen demonstrated acute myelogenous leukemia (M4 subtype). Following consultation with pediatric oncology and the recognition of the potential for spontaneous regression, chemotherapy for the infant's condition was not recommended. He remained otherwise healthy and was followed-up with biweekly to monthly complete blood counts and physical examinations, which were repeatedly normal. By 3 months of age, the nodules had completely resolved and there was no evidence of recurrence at 8 months of follow-up. We report this instance of aleukemic congenital leukemia with spontaneous regression of leukemia cutis without therapeutic intervention.
Case Details
Disease Location
Bone marrowithskin
Personal Characteristics
New born male , blood type a+ pregnancy was complicated by mild pre-eclampsia and abo incompatibility had mild jaundice which resolved with no treatment
Clinical Characteristics
Physical revealed multiple nonblanchable, blue-violaceous dermal nodules (0.5-2cm) in diameter on his scalp, face, neck, chest, abdomen, back, buttocks, and extremities, present at birth the nodules spared the mucous membranes, palms, and soles lab evaluation on day 2 found bilirubin was elevated at 9mg/dl hematoxylin-eosin stain of a skin biopsy from the left thigh demonstrated a dense, diffuse, atypical infiltrate replacing the entire dermis extending into subcutaneous adipose and sparing the epidermis and dermal-epidermal junction the atypical cells were arranged in sheets and were medium to large with round to oval nuclei and ispersed chromatin many cells had visible nucleoli with moderate amounts of slightly granular amphophilic cytoplasm, there were occasional mitotic figures, pyknotic nuclei, and apoptotic cells immunoperoxidase methods performed on paraffin sections resulted in positive staining of the atypical infiltrate with antibodies to CD4, 43, 68, myeloperoxidase and lysozyme diagnosis was extramedullary myeloid tumor with myelomonocytic immunophenotypic features atypical population was immunophenotypically and morphologically consistent with myeloid blasts marrow biopsy showed approx. 23% blasts of myeloid lineage granulopoiesis was left-shifted and hematogenous were slightly increased (these are typically higher in newborns and represent early normal b cell lymphocyte precursors) this was relevant because hematogenous can be similar to blasts seen in precursor b cell all stains for butyrate esterase, myeloperoxidase and sudan black b stained the immature cells positive diagnosis was then aleukemic congenital acute myeloid leukemia m4,myelomonocytic subtype 4/20 marrow cells were karyotype, there was a deletion of 8p, translocation between chromosomes 5 and 9, and the deletion of part of 14p
Remission Characteristics
Infant was clinically stable and was discharge without chemo serial cbcs performed at 2 to 4 week intervals for the past 8 months were in normal limits the leukemic cutaneous infiltrates resolved completely by 4 months of age with no residual skin lesions at 8 months of age, the child had no clinical signs or symptoms of acute leukemia
Treatment & Mechanisms
Proposed Remission Mechanisms
No major mechanism proposed
Clinical Treatment
None reported
Non-Clinical Treatment
None reported