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Leukemia Cutis Resembling Chalazion

Kassotis, Alexis S. B*; Wang, Marlene M.D.; Dagi Glass, Lora R. M.D.

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Ophthalmic Plastic and Reconstructive Surgery: November/December 2020 - Volume 36 - Issue 6 - p e160
doi: 10.1097/IOP.0000000000001578
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A 76-year-old man with acute myelomonocytic leukemia (AMML) cutis presented to our service with bilateral eyelid lesions (Fig. A, left eye) presumed to be chalazion by his primary oncologic team. Eyelid biopsy demonstrated infiltration of atypical myelomonocytic cells staining positive for CD33, CD43, and CD68, with similar immunophenotypic features to previously diagnosed acute myelomonocytic leukemia cutis. The accompanying figure (Fig. B, ×200) shows CD43 positivity, a common finding in myeloid and monocytic leukemias, with atypical myelomonocytes staining brown. The patient later developed right-sided ptosis and abduction deficit, with MRI demonstrating right optic nerve sheath enhancement (Fig. C, yellow arrow), thought to be secondary to central nervous system infiltration. He was treated with chemotherapy and whole-brain radiation with a regression of eyelid lesions (Fig. D). However, he ultimately succumbed to his condition. Leukemia cutis is a rare, neoplastic skin infiltration by leukemic cells. It is correlated with extramedullary infiltration and thus carries a poor prognosis.

Bilateral eyelid lesions resembling chalazia (A, left eye) were subsequently biopsied demonstrating infiltration of atypical myelomonocytic cells (B, CD43 stain, x200). After the patient developed right-sided ptosis, coronal T1 weighted MRI demonstrated optic nerve sheath enhancement (C, yellow arrow), likely due to central nervous system involvement. (D) Eyelid lesions regressed after treatment with chemotherapy and whole brain radiation therapy.
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