A 3 month-old girl presented with asymptomatic multiple erythematous to bluish patches and nodules on right eyelid, scalp, trunk, right arm and left thigh, which had developed about two months ago (Fig. 1). There were no specific findings on past history and family history. The remainder of physical examinations was unremarkable. On laboratory examination, there were no abnormal findings with complete blood cell count, peripheral blood smear and urinary analysis. A biopsy specimen taken from the skin of the left flank showed immature cells which are overall monotonous with large kidney shaped nucleus, prominent nucleoli and moderate cytoplasm (Fig. 2). On immunohisto- chemical staining, the specimen showed positive findings on LCA, the antigen of leukocytes. It also showed positive findings on lysozyme and CD68, the antigen of monocytes (Fig. 3). It stained negative for CD3, UCHL1, CD20, CD79a, myeloperoxidase and toluidine blue. This lesion was interpreted as acute monocytic leukemia.
Fig. 1. Erythematous to bluish patches on right eyelid.
On iliac bone marrow aspiration smears and iliac biopsy section, there were many monoblasts, with large nuclear-cytoplasmic ratio, kidney-shaped nucleus and moderate cytoplasm without eosinophilic granules. After considering all those results, she was diagnosed as congenital leukemia cutis. She was transferred to pediatric hemato-oncology department, and was started on induction chemotherapy for AML with Idarubicin and Behenoyl-ara-C (BH-AC).
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Fig. 2. Most of infiltrated cells are immature which are, overall monotonous with large kidney shaped nucleus, prominent nucleoli and moderate cytoplasm (H&E, x200).
After the remission, she underwent consolidation therapy with BH-AC, Mitox, IT Ara-C, and the leukemic cutaneous infiltrates resolved completely. Three months later, she underwent cord blood stem cell transplantation. Periodic examination during follow-up revealed no recurrence. Seven months after the cord blood stem cell transplantation, the bone marrow examination revealed a normal result. At the time of writing this report the infant was continuing to grow and develop normally. tadalis sx
Fig. 3. The infiltrative tumor cells show positive re-sponse to immunohistochemical staining with CD68 (x200).