Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Martinez Escaname Y Pinales, M.
Histopathologic diagnostic criteria for specific cutaneous manifestations of myelogenous leukemia and comparison with inflammatory dermatoses and blastic plasmacytoid dendritic cell neoplasm
Studium für die Gleichwertigkeit; Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2015. pp. 44
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Cerroni Lorenzo
- Fried Isabella
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- Abstract:
- Objetive: Establish reproducible histological and immunophenotypic criteria for routine histopathologic diagnosis of cutaneous manifestations of myelogenous leukemia (ML), and for differential diagnosis from other malignant and benign cutaneous disorders showing similar morphologic features. Introduction: The diagnosis of speci¿c cutaneous manifestations of ML is often difficult, and in some instances skin lesions may mimic in¿ammatory dermatoses. A precise diagnosis is very important because of the poor prognosis and the need to start adequate therapy as soon as possible. In this context, the differential diagnostic demarcation from benign conditions as well as from other hematological diseases such as blastic plasmacytoid dendritic cell neoplasm (BPDCN) is paramount. Material and Methods: We retrieved biopsies from 48 patients with a confirmed diagnosis of cutaneous ML. In cases with sufficient material, immunohistochemical stainings using a panel of antibodies for myelogenous and lymphatic cells as well as staining for naphthol chloroacetate esterase (NASDCl) were performed. In order to differentiate cutaneous ML from skin manifestations of BPDCN, histopathological and immunohistochemical results of biopsies from patients with cutaneous ML were compared with biopsies of 33 patients with proved diagnosis of BPDCN, which had been previously characterized. We also included for comparison 10 cases of pseudolymphomatous granuloma annulare (GA) which had also been previously characterized. Results: Clinically and histopathologically, two main patterns of skin infiltrates of ML were observed. One was characterized clinically by multiple nodules and plaques and histopathologically by dense, diffuse infiltrates of atypical myelomonocytic cells within the entire dermis, whereas the second presented with clinical features similar to those of inflammatory dermatoses, and histopathologically by relatively sparse dermal infiltrates of neoplastic cells. Immunohistochemical stainings revealed in both patterns similar features, characterized in the majority of cases by positivity for CD43, CD4, CD68, MPO, and NaSDCl. Other markers tested as CD33, CD56, CD34, CD117, CD123, CD13 and CD1a were positive only in a minority of specimens. Discussion: Our study shows that specific cutaneous manifestations of ML may present with different patterns, one of which is very difficult to distinguish from inflammatory dermatoses. Some antibodies proved useful in the distinction of ML from BPDCN, particularly MPO, CD123, CD56 and to a certain extent CD68. Distinction of cutaneous ML from inflammatory dermatosis and particularly from pseudolymphomatous GA rests upon careful examination of the histopathological features and application of a panel of antibodies. Accurate morphologic and phenotypic correlation together with a high index of suspicion are necessary for a precise diagnosis and classification of cutaneous ML, in order to allow a proper management of affected patients.