Leukemia Cutis Associated with Secondary Plasma Cell Leukemia.

Nicole C Demartinis,Philip R Cohen,Brian R Hinds,Megan M Brown

doi:10.7759/cureus.1235

Abstract

Plasma cell leukemia is an uncommon, aggressive variant of leukemia that may occur de novo or in association with multiple myeloma. Leukemia cutis is the cutaneous manifestation of leukemia, and indicates an infiltration of the skin by malignant leukocytes or their precursors. Plasma cell leukemia cutis is a rare clinical presentation of leukemia. We present a man who developed plasma cell leukemia cutis in association with multiple myeloma. Cutaneous nodules developed on his arms and legs 50 days following an autologous stem cell transplant. Histopathologic examination showed CD138-positive nodular aggregates of atypical plasma cells with kappa light chain restriction, similar to the phenotype of his myeloma. In spite of systemic treatment of his underlying disease, he died 25 days after the presentation of leukemia cutis. Pub-Med was searched for the following terms: cutaneous plasmacytomas, leukemia cutis, plasma cell leukemia nodules, plasma cell leukemia cutis, and secondary cutaneous plasmacytoma. Papers were reviewed and appropriate references evaluated. Leukemia cutis in plasma cell leukemia patients is an infrequent occurrence. New skin lesions in patients with plasma cell leukemia should be biopsied for pathology and for tissue cultures to evaluate for cancer or infection, respectively. The diagnosis plasma cell leukemia cutis is associated with a very poor prognosis.

Highlights

Plasma cell leukemia is an uncommon variant of leukemia that may occur de novo or in association with multiple myeloma
Leukemia cutis often presents in association with systemic leukemia, but can be a precocious manifestation, rarely appearing prior to leukemic cells appearing in peripheral blood or bone marrow
When plasma cell leukemia develops within the context of multiple myeloma, as in our patient, it is considered an aggressive variant of multiple myeloma [2]

Summary

Introduction

Plasma cell leukemia is an uncommon variant of leukemia that may occur de novo or in association with multiple myeloma. A 62-year-old man presented to the hospital for evaluation of progressive vision loss and back pain His past medical history was significant for plasma cell leukemia-multiple myeloma since September 2015. Distant view of the proximal right leg showing multiple erythematous, non-tender nodules. Non-tender nodules of leukemia cutis on the distal right leg. His laboratory studies from 11/14/2016 showed a total leukocyte count of 3.1 × 109/L with 45% polymorphonuclear cells and 30% lymphocytes. Plasma cell lineage was confirmed with CD138 immunolabeling of the neoplastic cells (Figure 9), and clonality was demonstrated with kappa-light chain restriction (Figures 10-11) These results corresponded to previous characteristics of the patient’s myeloma. The patient died at day 75 post-transplant, 25 days after his diagnosis of leukemia cutis

Discussion

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Disclosures