Cutaneous manifestations of hematological neoplastic processes with unfavorable evolution

Abstract

Hematological cancers are divided into lymphomas, leukemias and myeloma. Among the most aggressive forms of hematological cancers are anaplastic large cell lymphoma (ALCL) [1] and acute myeloblastic leukemia [3]. Cutaneous anaplastic large cell lymphoma (PC-ALCL) is a subtype of ALCL T-cell non-Hodjkin’s lymphoma (NHL) characterized by the presence of CD30-positive anaplastic large lymphoid cells. Clinical manifestations - single or multiple nodules that can ulcerate, are autoregressive and recurrent, usually asymptomatic[ 2]. One of the forms of acute myeloblastic leukemia is acute monoblastic leukemia (AML) in which more than 20% blast cells are detected in the bone marrow, 80% of which are monocytes[4]. Cutaneous manifestations in AML represent erythematous-violet papules and nodules, called leukemids, observed in 60% of patients, less often infiltrative plaques and erythroderma can be observed[5]. Objective of the study Elucidation the skin manifestations in patients with hematological cancers with aggressive evolution, in the light of two clinical cases. Case I: A 5 years history of disease in a 45-year-old man with skin lesions on the face, upper and lower limbs, and body. First manifestations were characterized by disseminated skin xerosis and chronic eczemas. From January 20, 2023, nodular formations appeared located on the calves, neck, upper limbs, groin, accompanied by a fever of 39C. Over time the lesions increased in volume. Dermatological status: nodules of different sizes 1-4 cm in diameter are observed on the face, upper and lower limbs and trunk, on the surface of which there are adherent, sero-purulent crusts. In some areas nodules are without ulcerations, of different sizes 0.5-3cm, hard to the touch, painless with unchanged surface. The biopsy was taken, which revealed specific modifications for PC-ALCL. Thoracic and abdominal CT revealed systemic involvement. Case II: Man, 66 years old, with disseminated skin lesions on the trunk and limbs. Sick for about 3 weeks, when moderate itching appeared on the trunk, then after 2 weeks, disseminated skin lesions appeared. Dermatological status: Lesions on the upper and lower limbs, abdomen. Morphologically, small, well-defined hemorrhagic papulo-nodular lesions of different sizes, mainly 0.2-0.3 cm, were determined, which did not disappear with vitropressure. Paraclinic: Gl- 6.1; ALATE 161; ASAT 137; FR 4+; CRP 2+; Hb 95; erythrocytes 2.9; hematocrit 29.5; platelets 78; leukocytes 188; lymphocytes 7.1; monocytes 87.3; granulocytes 5.3. He was consulted and investigated by the hematologist, who diagnosed Acute Leukemia, monoblastic variant. Discussions Both patients received specialized hemato-oncological treatment, but without improvement and subsequently with the death of the patients. The incidence of PCALCL among other types of peripheral T-cell NHL is 1.7%, so it can be misdiagnosed. The treatment of choice is cytostatics and immunosuppressants. In the absence of treatment, it can lead to systemic form and death[3]. The annual incidence of AML in Europe is estimated at 1/33,000 people [6], but the 5-year survival rate is 23.7% [7]. Conclusions Dermatological manifestations represent an important symptom present in some hematological pathologies. The first signs can be prolonged skin xerosis, eczematous lesions and skin itching. Thus, the caution of the dermatologist can allow early diagnosis and prolong the patient’s life.