Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report

Jay Patel; Emily Powell; Sarah Al-Awami; Chen Chen; Yve Huttenbach; Benjamin Musher; Ida Orengo

doi:doi:10.11648/j.ijcd.20210401.11

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Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report

Jay Patel, Emily Powell, Sarah Al-Awami, Chen Chen, Yve Huttenbach, Benjamin Musher, Ida Orengo

Published in International Journal of Clinical Dermatology (Volume 4, Issue 1)

Received: 27 April 2021 Accepted: 12 May 2021 Published: 21 May 2021

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Abstract

Background: Leukemia cutis is an extramedullary manifestation of leukemia with infiltration of neoplastic leukocytes into the epidermis, dermis, or subcutaneous tissues. Most often it is associated with myelodysplastic syndrome or acute myelogenous leukemia. Case History: Here we present a patient with new-onset, multiple, non-tender red papules, that were initially concerning for skin metastases of her previously diagnosed pancreatic ductal adenocarcinoma. She was previously diagnosed with pancreatic cancer six years prior and was in remission until one year prior when she was found to have pulmonary metastases. The metastatic pulmonary nodules were successfully treated with radiotherapy, and the patient was in surveillance prior to presenting with a two month history of rapidly growing pink nodules on her skin. Results: Skin biopsies initially indicated this was likely not metastatic pancreatic adenocarcinoma but rather a hematologic malignancy with monocytic blast dermal infiltration. A subsequent bone-marrow biopsy and staining indicated a second primary hematologic malignancy, acute myelogenous leukemia. With the patient’s previous chemotherapy history, this new malignancy could have been treatment related. However, genetic analysis revealed this was not likely as it did not harbor known phenotypes or markers of treatment related myelodysplastic syndrome or acute myelogenous leukemia including myelomonocytic leukemia with eosinophils (FAB M4EO) or an inversion in chromosome 16 (p13q22). Instead, cytogenetics and next-generation sequencing showed trisomy 8 and a gain of function missense mutation in U2AF1. Conclusion: Maintaining a broad differential and utilizing sequential diagnostic testing confirmed a blast phase de novo acute myelogenous leukemia, presenting as leukemia cutis. She was treated with decitabine and venetoclax and within a few days of initiation, her skin nodules had already begun to recede.

Published in	International Journal of Clinical Dermatology (Volume 4, Issue 1)
DOI	10.11648/j.ijcd.20210401.11
Page(s)	1-4
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Leukemia, Cutis, Acute, Myelogenous, Leukemia

References

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APA Style

Jay Patel, Emily Powell, Sarah Al-Awami, Chen Chen, Yve Huttenbach, et al. (2021). Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. International Journal of Clinical Dermatology, 4(1), 1-4. https://doi.org/10.11648/j.ijcd.20210401.11

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ACS Style

Jay Patel; Emily Powell; Sarah Al-Awami; Chen Chen; Yve Huttenbach, et al. Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. Int. J. Clin. Dermatol. 2021, 4(1), 1-4. doi: 10.11648/j.ijcd.20210401.11

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AMA Style

Jay Patel, Emily Powell, Sarah Al-Awami, Chen Chen, Yve Huttenbach, et al. Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. Int J Clin Dermatol. 2021;4(1):1-4. doi: 10.11648/j.ijcd.20210401.11

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@article{10.11648/j.ijcd.20210401.11,
  author = {Jay Patel and Emily Powell and Sarah Al-Awami and Chen Chen and Yve Huttenbach and Benjamin Musher and Ida Orengo},
  title = {Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report},
  journal = {International Journal of Clinical Dermatology},
  volume = {4},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijcd.20210401.11},
  url = {https://doi.org/10.11648/j.ijcd.20210401.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20210401.11},
  abstract = {Background: Leukemia cutis is an extramedullary manifestation of leukemia with infiltration of neoplastic leukocytes into the epidermis, dermis, or subcutaneous tissues. Most often it is associated with myelodysplastic syndrome or acute myelogenous leukemia. Case History: Here we present a patient with new-onset, multiple, non-tender red papules, that were initially concerning for skin metastases of her previously diagnosed pancreatic ductal adenocarcinoma. She was previously diagnosed with pancreatic cancer six years prior and was in remission until one year prior when she was found to have pulmonary metastases. The metastatic pulmonary nodules were successfully treated with radiotherapy, and the patient was in surveillance prior to presenting with a two month history of rapidly growing pink nodules on her skin. Results: Skin biopsies initially indicated this was likely not metastatic pancreatic adenocarcinoma but rather a hematologic malignancy with monocytic blast dermal infiltration. A subsequent bone-marrow biopsy and staining indicated a second primary hematologic malignancy, acute myelogenous leukemia. With the patient’s previous chemotherapy history, this new malignancy could have been treatment related. However, genetic analysis revealed this was not likely as it did not harbor known phenotypes or markers of treatment related myelodysplastic syndrome or acute myelogenous leukemia including myelomonocytic leukemia with eosinophils (FAB M4EO) or an inversion in chromosome 16 (p13q22). Instead, cytogenetics and next-generation sequencing showed trisomy 8 and a gain of function missense mutation in U2AF1. Conclusion: Maintaining a broad differential and utilizing sequential diagnostic testing confirmed a blast phase de novo acute myelogenous leukemia, presenting as leukemia cutis. She was treated with decitabine and venetoclax and within a few days of initiation, her skin nodules had already begun to recede.},
 year = {2021}
}

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TY  - JOUR
T1  - Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report
AU  - Jay Patel
AU  - Emily Powell
AU  - Sarah Al-Awami
AU  - Chen Chen
AU  - Yve Huttenbach
AU  - Benjamin Musher
AU  - Ida Orengo
Y1  - 2021/05/21
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcd.20210401.11
DO  - 10.11648/j.ijcd.20210401.11
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20210401.11
AB  - Background: Leukemia cutis is an extramedullary manifestation of leukemia with infiltration of neoplastic leukocytes into the epidermis, dermis, or subcutaneous tissues. Most often it is associated with myelodysplastic syndrome or acute myelogenous leukemia. Case History: Here we present a patient with new-onset, multiple, non-tender red papules, that were initially concerning for skin metastases of her previously diagnosed pancreatic ductal adenocarcinoma. She was previously diagnosed with pancreatic cancer six years prior and was in remission until one year prior when she was found to have pulmonary metastases. The metastatic pulmonary nodules were successfully treated with radiotherapy, and the patient was in surveillance prior to presenting with a two month history of rapidly growing pink nodules on her skin. Results: Skin biopsies initially indicated this was likely not metastatic pancreatic adenocarcinoma but rather a hematologic malignancy with monocytic blast dermal infiltration. A subsequent bone-marrow biopsy and staining indicated a second primary hematologic malignancy, acute myelogenous leukemia. With the patient’s previous chemotherapy history, this new malignancy could have been treatment related. However, genetic analysis revealed this was not likely as it did not harbor known phenotypes or markers of treatment related myelodysplastic syndrome or acute myelogenous leukemia including myelomonocytic leukemia with eosinophils (FAB M4EO) or an inversion in chromosome 16 (p13q22). Instead, cytogenetics and next-generation sequencing showed trisomy 8 and a gain of function missense mutation in U2AF1. Conclusion: Maintaining a broad differential and utilizing sequential diagnostic testing confirmed a blast phase de novo acute myelogenous leukemia, presenting as leukemia cutis. She was treated with decitabine and venetoclax and within a few days of initiation, her skin nodules had already begun to recede.
VL  - 4
IS  - 1
ER  -

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Author Information

Jay Patel

Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
Emily Powell

Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
Sarah Al-Awami

Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
Chen Chen

Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
Yve Huttenbach

Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
Benjamin Musher

Department of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA
Ida Orengo

Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA

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Plain Text BibTeX RIS

APA Style

Jay Patel, Emily Powell, Sarah Al-Awami, Chen Chen, Yve Huttenbach, et al. (2021). Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. International Journal of Clinical Dermatology, 4(1), 1-4. https://doi.org/10.11648/j.ijcd.20210401.11

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ACS Style

Jay Patel; Emily Powell; Sarah Al-Awami; Chen Chen; Yve Huttenbach, et al. Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. Int. J. Clin. Dermatol. 2021, 4(1), 1-4. doi: 10.11648/j.ijcd.20210401.11

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AMA Style

Jay Patel, Emily Powell, Sarah Al-Awami, Chen Chen, Yve Huttenbach, et al. Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report. Int J Clin Dermatol. 2021;4(1):1-4. doi: 10.11648/j.ijcd.20210401.11

Copy | Download

@article{10.11648/j.ijcd.20210401.11,
  author = {Jay Patel and Emily Powell and Sarah Al-Awami and Chen Chen and Yve Huttenbach and Benjamin Musher and Ida Orengo},
  title = {Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report},
  journal = {International Journal of Clinical Dermatology},
  volume = {4},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijcd.20210401.11},
  url = {https://doi.org/10.11648/j.ijcd.20210401.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20210401.11},
  abstract = {Background: Leukemia cutis is an extramedullary manifestation of leukemia with infiltration of neoplastic leukocytes into the epidermis, dermis, or subcutaneous tissues. Most often it is associated with myelodysplastic syndrome or acute myelogenous leukemia. Case History: Here we present a patient with new-onset, multiple, non-tender red papules, that were initially concerning for skin metastases of her previously diagnosed pancreatic ductal adenocarcinoma. She was previously diagnosed with pancreatic cancer six years prior and was in remission until one year prior when she was found to have pulmonary metastases. The metastatic pulmonary nodules were successfully treated with radiotherapy, and the patient was in surveillance prior to presenting with a two month history of rapidly growing pink nodules on her skin. Results: Skin biopsies initially indicated this was likely not metastatic pancreatic adenocarcinoma but rather a hematologic malignancy with monocytic blast dermal infiltration. A subsequent bone-marrow biopsy and staining indicated a second primary hematologic malignancy, acute myelogenous leukemia. With the patient’s previous chemotherapy history, this new malignancy could have been treatment related. However, genetic analysis revealed this was not likely as it did not harbor known phenotypes or markers of treatment related myelodysplastic syndrome or acute myelogenous leukemia including myelomonocytic leukemia with eosinophils (FAB M4EO) or an inversion in chromosome 16 (p13q22). Instead, cytogenetics and next-generation sequencing showed trisomy 8 and a gain of function missense mutation in U2AF1. Conclusion: Maintaining a broad differential and utilizing sequential diagnostic testing confirmed a blast phase de novo acute myelogenous leukemia, presenting as leukemia cutis. She was treated with decitabine and venetoclax and within a few days of initiation, her skin nodules had already begun to recede.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Leukemia Cutis in a Patient with Metastatic Pancreatic Cancer: A Case Report
AU  - Jay Patel
AU  - Emily Powell
AU  - Sarah Al-Awami
AU  - Chen Chen
AU  - Yve Huttenbach
AU  - Benjamin Musher
AU  - Ida Orengo
Y1  - 2021/05/21
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcd.20210401.11
DO  - 10.11648/j.ijcd.20210401.11
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20210401.11
AB  - Background: Leukemia cutis is an extramedullary manifestation of leukemia with infiltration of neoplastic leukocytes into the epidermis, dermis, or subcutaneous tissues. Most often it is associated with myelodysplastic syndrome or acute myelogenous leukemia. Case History: Here we present a patient with new-onset, multiple, non-tender red papules, that were initially concerning for skin metastases of her previously diagnosed pancreatic ductal adenocarcinoma. She was previously diagnosed with pancreatic cancer six years prior and was in remission until one year prior when she was found to have pulmonary metastases. The metastatic pulmonary nodules were successfully treated with radiotherapy, and the patient was in surveillance prior to presenting with a two month history of rapidly growing pink nodules on her skin. Results: Skin biopsies initially indicated this was likely not metastatic pancreatic adenocarcinoma but rather a hematologic malignancy with monocytic blast dermal infiltration. A subsequent bone-marrow biopsy and staining indicated a second primary hematologic malignancy, acute myelogenous leukemia. With the patient’s previous chemotherapy history, this new malignancy could have been treatment related. However, genetic analysis revealed this was not likely as it did not harbor known phenotypes or markers of treatment related myelodysplastic syndrome or acute myelogenous leukemia including myelomonocytic leukemia with eosinophils (FAB M4EO) or an inversion in chromosome 16 (p13q22). Instead, cytogenetics and next-generation sequencing showed trisomy 8 and a gain of function missense mutation in U2AF1. Conclusion: Maintaining a broad differential and utilizing sequential diagnostic testing confirmed a blast phase de novo acute myelogenous leukemia, presenting as leukemia cutis. She was treated with decitabine and venetoclax and within a few days of initiation, her skin nodules had already begun to recede.
VL  - 4
IS  - 1
ER  -

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