The Hematologist

November-December 2019, Volume 16, Issue 6

A Skin Lesion in a Pediatric Patient: A Close Call

Gabriela Gheorghe, MD Medical Director, Hematopathology/Flow Cytometry
Children's Minnesota, Minneapolis, MN
Girish Venkataraman, MD Editor in Chief, ASH Image Bank; Medical Director, Immunohistochemistry; Associate Professor, Department of Pathology
The University of Chicago Medicine, Chicago, IL

Published on: October 08, 2019

A 15-year-old girl presented with a three-month history of an erythematous rash on the medial side of the left breast. This was initially diagnosed as extramedullary myeloid tumor (EMMT). The patient received standard therapy for acute myeloid leukemia. Although bone marrow and cerebrospinal fluid analysis at the end of therapy showed no evidence of disease, there was cutaneous relapse in three months. An excisional skin biopsy was performed and showed an extensive/malignant appearing infiltrate involving dermis and underlying soft tissue and sparing epidermis and adnexal structures. Images of low- and high-power hematoxylin and eosin (H&E; Figures 1 and 2) as well as CD4 (Figure 3) and CD123 (Figure 4) immunostains are shown. In addition to these markers, a panel of immunostains revealed the dermal infiltrate to be positive for TdT, CD33, CD43, CD45, TCL1, TCF4, and CD68 KP1 (faint, focal).

Additionally, cytogenetics showed RB1 deletion and loss of chromosome 17.

Low-power hematoxylin and eosin

Low-Power H&E. Extensive, monotonous infiltrate composed of small- to medium-sized cells extending into the dermis. The epidermis is not involved (magnification x400).

High-power hematoxylin and eosin

High-Power H&E. High-power demonstrates blastoid medium-sized lymphoid cells with dispersed chromatin (magnification x100).

CD4 Immunostain

CD4 Immunostain (magnification x400).

CD123 Immunostain

CD123 Immunostain (magnification x400).



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