Case Report

Unusual Skin Lesions in Chronic Myelomonocytic Leukemia

Authors: Amy McCollum, BS, Carolyn L. Bigelow, MD, Stephanie L. Elkins, MD, Cheryl L. Hardy, PhD, Joe C. Files, MD

Abstract

Chronic myelomonocytic leukemia (CMML) is a relatively rare, heterogeneous syndrome classified as a myelodysplastic syndrome according to the French-American-British classification system. The patient's presenting symptom was a pigmented skin nodule that, although common for cases of acute monoblastic leukemia, is peculiar for CMML. This case should increase awareness of the inclusion of CMML in the differential diagnosis of a discolored nodule and highlight the clinicopathologic considerations and therapeutic challenges consistent with the diagnosis of CMML.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Zittoun R, Bernadou A, Bilski-Pasquier G, Bousser J. Subacute myelomonocytic leukemia: Study of 27 cases and review of the literature [in French]. Sem Hop 1972; 48: 1943–1956.
2. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 1982; 51: 189–199.
3. van der Weide M, Sizoo W, Krefft J, Langenhuijsen MM. Myelodysplastic syndromes: Analysis of morphological features related to the FAB-classification. Eur J Haematol 1988; 41: 58–61.
4. Duguid JKM, Mackie MJ, McVerry BA. Skin infiltration associated with CMML. Br J Haematol 1983; 53: 257–264.
5. Eubanks SW, Patterson JW. Subacute myelomonocytic leukemia: An unusual skin manifestation. J Am Acad Dermatol 1983; 9: 581–584.
6. Pozo-Roman T, Javier Menarguez-Palanca F, Gomez-Pineda A, Gonzalez-Herrada CM, Lazaro-Ochaita P. Specific cutaneous involvement in the course of chronic myelomonocytic leukemia simultaneously with blastic leukemic transformation: Report of a case with histologic and cytochemical study. J Am Acad Dermatol 1985; 12: 943–948.
7. Copplestone JA, Oscier DG, Mufti GJ, Hamblin TJ. Monocytic skin infiltration in chronic myelomonocytic leukaemia. Clin Lab Haematol 1986; 8: 115–119.
8. Braga D, Manganoni AM, Boccaletti V, Pancera C, Marocolo D, Facchetti F, et al. Specific skin infiltration as first sign of chronic myelomonocytic leukemia with an unusual phenotype. J Am Acad Dermatol 1996; 35: 804–807.
9. Avivi I, Rosenbaum H, Levy Y, Rowe J. Myelodysplastic syndrome and associated skin lesions: A review of the literature. Leuk Res 1999; 23: 323–330.
10. Martiat P, Michaux JL, Rodhain J. Philadelphia-negative (Ph−) chronic myeloid leukemia (CML): Comparison with Ph+ CML and chronic myelomonocytic leukemia. Blood 1991; 78: 205–211.
11. Tefferi A, Hoagland HC, Therneau TM, Pierre RV. Chronic myelomonocytic leukemia: Natural history and prognostic determinants. Mayo Clin Proc 1989; 64: 1246–1254.
12. Germing U, Gattermann N, Minning H, Heyll A, Aul C. Problems in the classification of CMML: Dysplastic versus proliferative type. Leuk Res 1998; 22: 871–878.
13. Goasguen JE, Bennett JM. Classification and morphologic features of the myelodysplastic syndromes. Semin Oncol 1992; 19: 4–13.
14. Naeim F. Bone marrow examination: Special procedures, in Pathology of Bone Marrow. Baltimore, Williams & Wilkins, 1998, ed 2, pp 46–60.
15. Griffin JD, Linch D, Sabbath K, Larcom P, Schlossman SF. A monoclonal antibody reactive with normal and leukemic human myeloid progenitor cells. Leuk Res 1984; 8: 521–534.
16. Ponzio G, Rege-Cambrin G, Neretto G. Loss of band 13q14 in a myelodysplastic syndrome. Cancer Genet Cytogenet 1987; 28: 181–182.
17. Fenaux P, Morel P, Lai JL. Cytogenetics of myelodysplastic syndromes. Semin Hematol 1996; 33: 127–138.
18. Vidal C, Baer MR, Bloomfield CD. Uncommon patterns of presentation of leukemia. Hematol Oncol 1999; 17: 11–29.
19. Cambier N, Baruchel A, Schlageter MH, Menot ML, Wattel E, Fenaux P, et al. Chronic myelomonocytic leukemia: From biology to therapy. Hematol Cell Ther 1997; 39: 41–48.
20. Appelbaum FR. Allogeneic bone marrow transplantation for myelodysplastic and myeloproliferative disorders, in Forman SJ, Blume KG, Thomas ED (eds): Bone Marrow Transplantation. Boston, Blackwell Scientific Publications, 1994, pp 629–639.
21. Klingemann HG, Storb R, Fefer A, Deeg HJ, Appelbaum FR, Buckner CD, et al. Bone marrow transplantation in patients aged 45 years and older. Blood 1986; 67: 770–776.

I can think of only one person Who welcomes a change: a wet baby. - —Author unknown