array:24 [
  "pii" => "S1578219011000965"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.11.009"
  "estado" => "S300"
  "fechaPublicacion" => "2011-11-01"
  "aid" => "398"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "cita" => "Actas Dermosifiliogr. 2011;102:737-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4095
    "formatos" => array:3 [
      "EPUB" => 38
      "HTML" => 3322
      "PDF" => 735
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731011002158"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2010.12.017"
      "estado" => "S300"
      "fechaPublicacion" => "2011-11-01"
      "aid" => "398"
      "copyright" => "Elsevier España, S.L. y AEDV"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "cor"
      "cita" => "Actas Dermosifiliogr. 2011;102:737-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4632
        "formatos" => array:3 [
          "EPUB" => 1
          "HTML" => 3685
          "PDF" => 946
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Sarcoma mieloide en un &#225;rea de plastia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "737"
            "paginaFinal" => "739"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Myeloid Sarcoma in the Area of a Skin Flap"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 562
                "Ancho" => 950
                "Tamanyo" => 160429
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detalle de la celularidad&#58; proliferaci&#243;n neopl&#225;sica difusa constituida por c&#233;lulas mononucleares de mediano tama&#241;o&#44; de morfolog&#237;a redondeada y oval&#44; citoplasma eosin&#243;filo y n&#250;cleo bas&#243;filo&#44; presentando indentaciones algunos de ellos &#40;HE x40&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Garc&#237;a-Arpa, M&#46; Rodr&#237;guez-V&#225;zquez, C&#46; Murillo L&#225;zaro, C&#46; Calle Primo"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Garc&#237;a-Arpa"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Rodr&#237;guez-V&#225;zquez"
              ]
              2 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Murillo L&#225;zaro"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Calle Primo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219011000965"
          "doi" => "10.1016/j.adengl.2011.11.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000965?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011002158?idApp=UINPBA000044"
      "url" => "/00017310/0000010200000009/v1_201304241340/S0001731011002158/v1_201304241340/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219011000977"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2011-11-01"
    "aid" => "399"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2011;102:739-40"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 15189
      "formatos" => array:3 [
        "EPUB" => 49
        "HTML" => 12619
        "PDF" => 2521
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and research letters</span>"
      "titulo" => "Pigmentation of the Fungiform Papillae of the Tongue&#58; A Report of 2 Cases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "739"
          "paginaFinal" => "740"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Pigmentaci&#243;n de las papilas fungiformes linguales&#46; A prop&#243;sito de dos casos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 625
              "Ancho" => 952
              "Tamanyo" => 95027
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2&#46; Pigmented fungiform papillae of the tongue with a diffuse symmetrical pattern&#44; predominantly affecting the lateral surfaces of the tongue in an indigenous South American woman&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Marcoval, J&#46; Notario, S&#46; Mart&#237;n-Sala, I&#46; Figueras"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Marcoval"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Notario"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Mart&#237;n-Sala"
            ]
            3 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Figueras"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101100216X"
        "doi" => "10.1016/j.ad.2011.01.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101100216X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000977?idApp=UINPBA000044"
    "url" => "/15782190/0000010200000009/v1_201304241238/S1578219011000977/v1_201304241238/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219011000916"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.11.004"
    "estado" => "S300"
    "fechaPublicacion" => "2011-11-01"
    "aid" => "370"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2011;102:735-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4427
      "formatos" => array:3 [
        "EPUB" => 51
        "HTML" => 3555
        "PDF" => 821
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and research letters</span>"
      "titulo" => "Pemphigoid Gestationis&#58; Therapeutic Response to Pre- and Postpartum Immunoglobulin Therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "735"
          "paginaFinal" => "737"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Penfigoide gestacional&#46; Respuesta terap&#233;utica a inmunoglobulinas pre y postparto"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 970
              "Ancho" => 1397
              "Tamanyo" => 121273
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Papular eruption with tense blisters on the patient&#39;s abdomen&#46; B&#44; Condition of the patient at 6 weeks after delivery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Ruiz-Villaverde, D&#46; S&#225;nchez-Cano, C&#46;L&#46; Ramirez-Tortosa"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Ruiz-Villaverde"
            ]
            1 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "S&#225;nchez-Cano"
            ]
            2 => array:2 [
              "nombre" => "C&#46;L&#46;"
              "apellidos" => "Ramirez-Tortosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011001360"
        "doi" => "10.1016/j.ad.2011.02.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011001360?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000916?idApp=UINPBA000044"
    "url" => "/15782190/0000010200000009/v1_201304241238/S1578219011000916/v1_201304241238/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Myeloid Sarcoma in the Area of a Skin Flap"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Editor&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "737"
        "paginaFinal" => "739"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Garc&#237;a-Arpa, M&#46; Rodr&#237;guez-V&#225;zquez, C&#46; Murillo L&#225;zaro, C&#46; Calle Primo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a-Arpa"
            "email" => array:1 [
              0 => "mgarciaa73&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Rodr&#237;guez-V&#225;zquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Murillo L&#225;zaro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Calle Primo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General de Ciudad Real&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General de Albacete&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital General de Ciudad Real&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Hematolog&#237;a&#44; Hospital General de Ciudad Real&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Sarcoma mieloide en un &#225;rea de plastia"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 563
            "Ancho" => 952
            "Tamanyo" => 159171
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cytology&#58; diffuse neoplastic proliferation formed of round&#47;oval medium-sized mononuclear cells with eosinophilic cytoplasm and basophilic nuclei&#44; several of which had indentations &#40;hematoxylin-eosin&#44; original magnification &#215;40&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leukemia cutis&#44; which is the infiltration of leukocytes into the skin&#44; is rare and accounts for just 3&#46;1&#37; of all types of leukemia&#46; The subtypes that most commonly affect the skin are monocytic acute myeloid leukemia &#40;AML-M5 &#91;French-American-British classification&#93;&#41; and acute myelomonocytic leukemia &#40;AML-M4&#41;&#44; with a respective prevalence of 33&#37; and 13&#37; to 18&#37;&#41;&#46; Myeloid sarcoma&#44; formerly known as granulocytic sarcoma&#44; is an extramedullary tumor composed of immature myeloid cells&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the skin is among the organs most frequently affected by myeloid sarcoma&#44; this tumor is still a rare variant of leukemia cutis&#46; We report the case of a patient with myeloid sarcoma in the area of a skin flap&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient&#44; an 86-year-old man&#44; had been diagnosed with myelodysplastic syndrome 2 years earlier&#46; He had consulted for 2 basal cell carcinomas&#44; one on the left temple and the other on the right ala nasi&#46; Both tumors were excised&#46; The surgical defect was repaired by direct closure in the first case and with a nasolabial fold flap in the second&#46; A few hours after surgery&#44; the patient presented at the emergency department with diffuse hemorrhage from both surgical wounds and a large hematoma in the area of the skin flap&#46; Laboratory tests showed a leukocyte count of 12&#160;200&#47;&#956;L &#40;upper limit of normal&#44; 10&#160;000&#47;&#956;L&#59; neutrophils&#44; 31&#46;2&#37;&#59; lymphocytes&#44; 21&#46;3&#37;&#59; monocytes&#44; 43&#46;6&#37;&#41;&#59; a hemoglobin level of 11&#46;7<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;lower limit of normal&#44; 13<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#44; a platelet count of 65&#160;000&#47;&#956;L &#40;lower limit of normal&#44;&#160;150&#160;000&#47;&#956;L&#41;&#44; and a creatinine level of 1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;upper limit of normal&#44;&#160;1&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; The other tests &#40;coagulation studies&#44; liver function tests&#44; and lactate dehydrogenase&#41; were normal&#46; One month after surgery&#44; a fast-growing asymptomatic nodule appeared in the area of the skin flap&#44; accompanied by progressive infiltration of the lower part of the flap &#40;which had healed perfectly&#41; and ulceration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Biopsy of the nodule and the infiltrated scar revealed a diffuse neoplastic proliferation of medium-sized&#44; round&#47;oval mononuclear cells with eosinophilic cytoplasm and basophilic nuclei in the dermis and adipose tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemical staining showed diffuse positivity for myeloperoxidase &#40;MPO&#41;&#44; CD68&#44; and CD43&#44; and focal positivity for CD34&#44; leading to a diagnosis of myeloid sarcoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; During this time&#44; the patient&#39;s myelodysplastic syndrome progressed to AML-M4&#46; Palliative treatment was initiated with thioguanine&#44; but the patient died 3 weeks later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Myeloid sarcoma presents as one or more tumor masses composed of immature myeloid cells&#46; While the tumors can affect any part of the body except the bone marrow&#44; the most common sites of involvement are bone&#44; periosteum&#44; skin&#44; gums&#44; and lymph nodes&#46; Multifocal disease is seen in less than 10&#37; of cases&#46; Myeloid sarcoma can precede&#44; coincide with&#44; or indicate recurrence of AML&#46; It can also indicate blastic transformation of a myelodysplastic syndrome&#44; chronic myeloid leukemia&#44; or other myeloproliferative disorders&#46; It is slightly more common in men than in women &#40;male to female ratio&#44; 1&#46;42&#58;1&#41; and in advanced ages &#40;mean age at diagnosis&#44; 56 years&#41;&#46; Myeloid sarcoma of the skin presents as a solitary tumor that grows in a matter of days or weeks and typically affects the face&#44; the scalp&#44; or the trunk&#46; There have also been reports of multiple and even disseminated lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> The literature contains approximately 20 reports of myeloid sarcoma in leukemia cutis&#44; arising at sites of previous skin lesions or trauma&#44; mainly at central venous catheterization sites &#40;11 cases&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and puncture sites for venous and arterial sampling and bone marrow aspiration &#40;4 cases&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> There have also been isolated reports of myeloid sarcoma at sites of extravasation of chemotherapy agents&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> traumatic scars and excoriations&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Mantoux test injection sites&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> decubitus ulcer&#44; Sister Mary Joseph&#39;s nodule&#44; pyoderma gangrenosum&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> tetanus booster injection sites&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and within a basal cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> We reexamined the surgical specimens from the basal cell carcinomas removed from the patient&#39;s temple and nose but found no evidence of leukemic infiltration&#46; Myeloid sarcoma in a patient with AML is normally a marker of recurrence and rapid disease progression&#46; Of 4 such cases described in the literature&#44; it was aleukemic in just 1 case<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#59; in the other 3&#44; its appearance coincided with transformation of a myelodysplastic syndrome into AML&#46; Prognosis is generally very poor&#46; It is noteworthy that while text books state that leukemia cutis can occur at the site of surgical scars&#44; we found no such cases reported in the literature&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histologic diagnosis of myeloid sarcoma requires a high level of clinical suspicion and diagnosis might be missed if there is no previous history of AML&#46; Histologic findings include dense neoplastic infiltration of the dermis and adipose tissue&#44; typically most intense around vessels and adnexa&#44; without epidermotropism&#46; The papillary dermis is usually spared &#40;Grenz zone&#41;&#46; Cytology varies greatly according to the origin of the tumor and the degree of cell maturation&#46; Immunohistochemical studies are essential for diagnosis&#44; with CD68&#44; MPO&#44; CD43&#44; CD3&#44; CD20&#44; and chloroacetate esterase staining recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The pathogenesis of leukemia cutis and myeloid sarcoma is not clear&#44; but it appears to be influenced by both the type of leukemia and local factors&#46; Infiltration would appear to be more common in monocytic variants because neoplastic monocytes have a greater capacity to adhere to vessel walls and invade extravascular spaces&#44; forming skin tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;8</span></a> Nevertheless&#44; local skin trauma of any type can activate keratinocytes or fibroblasts in old lesions&#44; releasing chemotactic factors for leukocytes and inflammatory cells that would lead to the recruitment of leukemic cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Of particular interest in the case presented is the fact that the leukemic infiltration was confined to the area of the skin flap&#44; ie&#44; it did not affect the surgical defect repaired by direct closure&#46; This might be because skin flap surgery causes greater tissue damage than direct closure&#44; and this damage&#44; combined with the profuse hemorrhage and subsequent hematoma &#40;related to the patient&#39;s underlying disease&#41;&#44; would have caused greater local inflammation&#44; which&#44; in turn&#44; would have promoted the recruitment of leukemic cells in a process that coincided with the transformation of myelodysplastic syndrome to AML&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Garc&#237;a-Arpa M&#44; et al&#46; Sarcoma mieloide en un &#225;rea de plastia&#46; Actas Dermosifiliogr&#46;2011&#59;102&#58;737-739&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 638
            "Ancho" => 851
            "Tamanyo" => 113710
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nodule of firm consistency measuring 1<span class="elsevierStyleHsp" style=""></span>cm&#44; with multiple telangiectases in the upper part of the skin flap and infiltration in the lower part of the scar&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 563
            "Ancho" => 952
            "Tamanyo" => 159171
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cytology&#58; diffuse neoplastic proliferation formed of round&#47;oval medium-sized mononuclear cells with eosinophilic cytoplasm and basophilic nuclei&#44; several of which had indentations &#40;hematoxylin-eosin&#44; original magnification &#215;40&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 563
            "Ancho" => 952
            "Tamanyo" => 150520
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical staining&#58; diffuse cytoplasmic positivity for myeloperoxidase&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myeloid Sarcoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Pileri"
                            1 => "A&#46; Orazi"
                            2 => "B&#46; Falini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "WHO classification of tumours of haematopoietic and lymphoid tissues"
                        "fecha" => "2008"
                        "editorial" => "WHO"
                        "editorialLocalizacion" => "Switzerland"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myeloid leucemia cutis&#58; a histologic and immunohistochemical review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;L&#46; Cibull"
                            1 => "A&#46;B&#46; Thomas"
                            2 => "D&#46;P&#46; O&#8217;Malley"
                            3 => "S&#46;D&#46; Billings"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0560.2007.00784.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Pathol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18190442"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Specific cutaneous infiltrates in patients with myelogenous leukemia&#58; a clinicopathologic study of 26 patients with assessment of diagnostic criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Kaddu"
                            1 => "P&#46; Zenahlik"
                            2 => "C&#46; Beham-Schmid"
                            3 => "H&#46; Kerl"
                            4 => "L&#46; Cerroni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1999"
                        "volumen" => "40"
                        "paginaInicial" => "966"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10365929"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leukemia cutis in acute myelomonocytic leukemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;J&#46; Baden"
                            1 => "W&#46;R&#46; Gammon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1987"
                        "volumen" => "123"
                        "paginaInicial" => "88"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3467659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous promyelocytic sarcoma sites at sites of vascular access and marrow aspiration&#46; A characteristic localization of chloromas in acute promyelocytic leukemia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Sanz"
                            1 => "L&#46; Larrea"
                            2 => "G&#46;F&#46; Sanz"
                            3 => "G&#46; Mart&#237;n"
                            4 => "A&#46; Sempere"
                            5 => "F&#46; Gomis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Haematologica"
                        "fecha" => "2000"
                        "volumen" => "85"
                        "paginaInicial" => "758"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10897129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leukaemia cutis originating in the extravasation site of iv gabexate mesilate infusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Miyakura"
                            1 => "T&#46; Yamamoto"
                            2 => "Y&#46; Kurashige"
                            3 => "A&#46; Nagal"
                            4 => "T&#46; Iguchi"
                            5 => "Y&#46; Aota"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.2007.00407.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "29"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18181773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous granulocytic sarcoma arising at the site of radiotherapy for breast carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Deruelle"
                            1 => "B&#46; Catteau"
                            2 => "M&#46; Segard"
                            3 => "E&#46; Martin De Lassalle"
                            4 => "P&#46; Fenaux"
                            5 => "F&#46; Piette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2001"
                        "volumen" => "11"
                        "paginaInicial" => "254"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11358737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leukaemia cutis in acute myelomonocytic leukaemia&#58; infiltration of minor traumas and scars"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Koizumi"
                            1 => "M&#46; Kumakiri"
                            2 => "M&#46; Ishizuka"
                            3 => "A&#46; Ohkawara"
                            4 => "S&#46; Okabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "1991"
                        "volumen" => "18"
                        "paginaInicial" => "281"
                        "paginaFinal" => "285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1939854"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myeloid sarcoma developing in pre-existing pyoderma gangrenoso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;B&#46; Kristensen"
                            1 => "H&#46; Moller"
                            2 => "M&#46;W&#46; Kjaershov"
                            3 => "K&#46; Yderstraede"
                            4 => "M&#46;B&#46; Moller"
                            5 => "O&#46;J&#46; Bergmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-0590"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2009"
                        "volumen" => "89"
                        "paginaInicial" => "175"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19326005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leucemia cutis desarrollada en la zona de inoculaci&#243;n de una dosis de recuerdo de la vacuna del t&#233;tanos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;M&#46; Guinovart"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "C&#46; Ferr&#225;ndiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "727"
                        "paginaFinal" => "729"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20965018"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Granulocytic sarcoma &#40;leukaemia cutis&#41; in association with basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;H&#46; Youssef"
                            1 => "U&#46; Zanetto"
                            2 => "M&#46;R&#46; Kaur"
                            3 => "S&#46;Y&#46; Chan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2005.07029.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2005"
                        "volumen" => "154"
                        "paginaInicial" => "201"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16403127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010200000009/v1_201304241238/S1578219011000965/v1_201304241238/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010200000009/v1_201304241238/S1578219011000965/v1_201304241238/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000965?idApp=UINPBA000044"
]
Compartir
Información de la revista
Vol. 102. Núm. 9.
Páginas 737-739 (noviembre 2011)
Vol. 102. Núm. 9.
Páginas 737-739 (noviembre 2011)
Case and Research Letters
Acceso a texto completo
Myeloid Sarcoma in the Area of a Skin Flap
Sarcoma mieloide en un área de plastia
Visitas
9846
M. García-Arpaa,
Autor para correspondencia
mgarciaa73@yahoo.es

Corresponding author.
, M. Rodríguez-Vázquezb, C. Murillo Lázaroc, C. Calle Primod
a Servicio de Dermatología, Hospital General de Ciudad Real, Spain
b Servicio de Dermatología, Hospital General de Albacete, Spain
c Servicio de Anatomía Patológica, Hospital General de Ciudad Real, Spain
d Servicio de Hematología, Hospital General de Ciudad Real, Spain
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (3)
Mostrar másMostrar menos
Texto completo
To the Editor:

Leukemia cutis, which is the infiltration of leukocytes into the skin, is rare and accounts for just 3.1% of all types of leukemia. The subtypes that most commonly affect the skin are monocytic acute myeloid leukemia (AML-M5 [French-American-British classification]) and acute myelomonocytic leukemia (AML-M4), with a respective prevalence of 33% and 13% to 18%). Myeloid sarcoma, formerly known as granulocytic sarcoma, is an extramedullary tumor composed of immature myeloid cells.1 Although the skin is among the organs most frequently affected by myeloid sarcoma, this tumor is still a rare variant of leukemia cutis. We report the case of a patient with myeloid sarcoma in the area of a skin flap.

The patient, an 86-year-old man, had been diagnosed with myelodysplastic syndrome 2 years earlier. He had consulted for 2 basal cell carcinomas, one on the left temple and the other on the right ala nasi. Both tumors were excised. The surgical defect was repaired by direct closure in the first case and with a nasolabial fold flap in the second. A few hours after surgery, the patient presented at the emergency department with diffuse hemorrhage from both surgical wounds and a large hematoma in the area of the skin flap. Laboratory tests showed a leukocyte count of 12 200/μL (upper limit of normal, 10 000/μL; neutrophils, 31.2%; lymphocytes, 21.3%; monocytes, 43.6%); a hemoglobin level of 11.7g/dL (lower limit of normal, 13g/dL), a platelet count of 65 000/μL (lower limit of normal, 150 000/μL), and a creatinine level of 1.5mg/dL (upper limit of normal, 1.3mg/dL). The other tests (coagulation studies, liver function tests, and lactate dehydrogenase) were normal. One month after surgery, a fast-growing asymptomatic nodule appeared in the area of the skin flap, accompanied by progressive infiltration of the lower part of the flap (which had healed perfectly) and ulceration (Fig. 1). Biopsy of the nodule and the infiltrated scar revealed a diffuse neoplastic proliferation of medium-sized, round/oval mononuclear cells with eosinophilic cytoplasm and basophilic nuclei in the dermis and adipose tissue (Fig. 2). Immunohistochemical staining showed diffuse positivity for myeloperoxidase (MPO), CD68, and CD43, and focal positivity for CD34, leading to a diagnosis of myeloid sarcoma (Fig. 3). During this time, the patient's myelodysplastic syndrome progressed to AML-M4. Palliative treatment was initiated with thioguanine, but the patient died 3 weeks later.

Figure 1.

Nodule of firm consistency measuring 1cm, with multiple telangiectases in the upper part of the skin flap and infiltration in the lower part of the scar.

(0.11MB).
Figure 2.

Cytology: diffuse neoplastic proliferation formed of round/oval medium-sized mononuclear cells with eosinophilic cytoplasm and basophilic nuclei, several of which had indentations (hematoxylin-eosin, original magnification ×40).

(0.15MB).
Figure 3.

Immunohistochemical staining: diffuse cytoplasmic positivity for myeloperoxidase.

(0.14MB).

Myeloid sarcoma presents as one or more tumor masses composed of immature myeloid cells. While the tumors can affect any part of the body except the bone marrow, the most common sites of involvement are bone, periosteum, skin, gums, and lymph nodes. Multifocal disease is seen in less than 10% of cases. Myeloid sarcoma can precede, coincide with, or indicate recurrence of AML. It can also indicate blastic transformation of a myelodysplastic syndrome, chronic myeloid leukemia, or other myeloproliferative disorders. It is slightly more common in men than in women (male to female ratio, 1.42:1) and in advanced ages (mean age at diagnosis, 56 years). Myeloid sarcoma of the skin presents as a solitary tumor that grows in a matter of days or weeks and typically affects the face, the scalp, or the trunk. There have also been reports of multiple and even disseminated lesions.1–4 The literature contains approximately 20 reports of myeloid sarcoma in leukemia cutis, arising at sites of previous skin lesions or trauma, mainly at central venous catheterization sites (11 cases)4 and puncture sites for venous and arterial sampling and bone marrow aspiration (4 cases).5 There have also been isolated reports of myeloid sarcoma at sites of extravasation of chemotherapy agents,6 traumatic scars and excoriations,8 Mantoux test injection sites,3 decubitus ulcer, Sister Mary Joseph's nodule, pyoderma gangrenosum,9 tetanus booster injection sites,10 and within a basal cell carcinoma.11 We reexamined the surgical specimens from the basal cell carcinomas removed from the patient's temple and nose but found no evidence of leukemic infiltration. Myeloid sarcoma in a patient with AML is normally a marker of recurrence and rapid disease progression. Of 4 such cases described in the literature, it was aleukemic in just 1 case7; in the other 3, its appearance coincided with transformation of a myelodysplastic syndrome into AML. Prognosis is generally very poor. It is noteworthy that while text books state that leukemia cutis can occur at the site of surgical scars, we found no such cases reported in the literature.

Histologic diagnosis of myeloid sarcoma requires a high level of clinical suspicion and diagnosis might be missed if there is no previous history of AML. Histologic findings include dense neoplastic infiltration of the dermis and adipose tissue, typically most intense around vessels and adnexa, without epidermotropism. The papillary dermis is usually spared (Grenz zone). Cytology varies greatly according to the origin of the tumor and the degree of cell maturation. Immunohistochemical studies are essential for diagnosis, with CD68, MPO, CD43, CD3, CD20, and chloroacetate esterase staining recommended.2,3

The pathogenesis of leukemia cutis and myeloid sarcoma is not clear, but it appears to be influenced by both the type of leukemia and local factors. Infiltration would appear to be more common in monocytic variants because neoplastic monocytes have a greater capacity to adhere to vessel walls and invade extravascular spaces, forming skin tumors.4,8 Nevertheless, local skin trauma of any type can activate keratinocytes or fibroblasts in old lesions, releasing chemotactic factors for leukocytes and inflammatory cells that would lead to the recruitment of leukemic cells.8,9 Of particular interest in the case presented is the fact that the leukemic infiltration was confined to the area of the skin flap, ie, it did not affect the surgical defect repaired by direct closure. This might be because skin flap surgery causes greater tissue damage than direct closure, and this damage, combined with the profuse hemorrhage and subsequent hematoma (related to the patient's underlying disease), would have caused greater local inflammation, which, in turn, would have promoted the recruitment of leukemic cells in a process that coincided with the transformation of myelodysplastic syndrome to AML.

References
[1]
S.A. Pileri, A. Orazi, B. Falini.
Myeloid Sarcoma.
WHO classification of tumours of haematopoietic and lymphoid tissues, WHO, (2008),
[2]
T.L. Cibull, A.B. Thomas, D.P. O’Malley, S.D. Billings.
Myeloid leucemia cutis: a histologic and immunohistochemical review.
J Cutan Pathol, 35 (2008), pp. 180-185
[3]
S. Kaddu, P. Zenahlik, C. Beham-Schmid, H. Kerl, L. Cerroni.
Specific cutaneous infiltrates in patients with myelogenous leukemia: a clinicopathologic study of 26 patients with assessment of diagnostic criteria.
J Am Acad Dermatol, 40 (1999), pp. 966-978
[4]
T.J. Baden, W.R. Gammon.
Leukemia cutis in acute myelomonocytic leukemia.
Arch Dermatol, 123 (1987), pp. 88-90
[5]
M.A. Sanz, L. Larrea, G.F. Sanz, G. Martín, A. Sempere, F. Gomis, et al.
Cutaneous promyelocytic sarcoma sites at sites of vascular access and marrow aspiration. A characteristic localization of chloromas in acute promyelocytic leukemia?.
Haematologica, 85 (2000), pp. 758-762
[6]
T. Miyakura, T. Yamamoto, Y. Kurashige, A. Nagal, T. Iguchi, Y. Aota, et al.
Leukaemia cutis originating in the extravasation site of iv gabexate mesilate infusion.
[7]
R. Deruelle, B. Catteau, M. Segard, E. Martin De Lassalle, P. Fenaux, F. Piette.
Cutaneous granulocytic sarcoma arising at the site of radiotherapy for breast carcinoma.
Eur J Dermatol, 11 (2001), pp. 254-256
[8]
H. Koizumi, M. Kumakiri, M. Ishizuka, A. Ohkawara, S. Okabe.
Leukaemia cutis in acute myelomonocytic leukaemia: infiltration of minor traumas and scars.
J Dermatol, 18 (1991), pp. 281-285
[9]
I.B. Kristensen, H. Moller, M.W. Kjaershov, K. Yderstraede, M.B. Moller, O.J. Bergmann.
Myeloid sarcoma developing in pre-existing pyoderma gangrenoso.
Acta Derm Venereol, 89 (2009), pp. 175-177
[10]
R.M. Guinovart, J.M. Carrascosa, C. Ferrándiz.
Leucemia cutis desarrollada en la zona de inoculación de una dosis de recuerdo de la vacuna del tétanos.
Actas Dermosifiliogr, 101 (2010), pp. 727-729
[11]
A.H. Youssef, U. Zanetto, M.R. Kaur, S.Y. Chan.
Granulocytic sarcoma (leukaemia cutis) in association with basal cell carcinoma.
Br J Dermatol, 154 (2005), pp. 201-202

Please cite this article as: García-Arpa M, et al. Sarcoma mieloide en un área de plastia. Actas Dermosifiliogr.2011;102:737-739.

Copyright © 2010. Elsevier España, S.L. and AEDV
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?