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A Rare Case of Acute Leukemic Presentation of Blastic Plasmacytoid Dendritic Cell Neoplasm without Cutaneous Lesions

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참고문헌

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초록

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a clinically aggressive phenotype arising from CD4/CD56-expressing plasmacytoid dendritic cell precursors [1]. BPDCN was categorized under “AML and re- lated precursor neoplasms” by the 2008 WHO classification, with most cases having been previously classified as blastic nat- ural killer (NK)-cell lymphoma/leukemia or agranular CD4+, CD56+ hematodermic neoplasm [2]. BPDCN cells generally ex- press CD4, CD56, CD123, and TCL-1 but are negative for other T-, B-, NK-cell, or myeloid markers [3]. Clinically, patients with this disease typically present with a high incidence of cutaneous involvement described as generalized, localized, or solitary mac- ules, plaques, and/or tumors, as the first manifestation, followed by involvement of bone marrow (BM), peripheral blood (PB), and lymph nodes (LNs). BM involvement usually occurs with leukemic progression of advanced or relapsed disease and is associated with a poor prognosis [4]. Diagnosis of leukemic BP- DCN without cutaneous manifestation is rare. Here, we report a 41-yr-old man who was diagnosed with BPDCN in the absence of skin manifestation.

Abstract

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a clinically aggressive phenotype arising from CD4/CD56-expressing plasmacytoid dendritic cell precursors [1]. BPDCN was categorized under “AML and re- lated precursor neoplasms” by the 2008 WHO classification, with most cases having been previously classified as blastic nat- ural killer (NK)-cell lymphoma/leukemia or agranular CD4+, CD56+ hematodermic neoplasm [2]. BPDCN cells generally ex- press CD4, CD56, CD123, and TCL-1 but are negative for other T-, B-, NK-cell, or myeloid markers [3]. Clinically, patients with this disease typically present with a high incidence of cutaneous involvement described as generalized, localized, or solitary mac- ules, plaques, and/or tumors, as the first manifestation, followed by involvement of bone marrow (BM), peripheral blood (PB), and lymph nodes (LNs). BM involvement usually occurs with leukemic progression of advanced or relapsed disease and is associated with a poor prognosis [4]. Diagnosis of leukemic BP- DCN without cutaneous manifestation is rare. Here, we report a 41-yr-old man who was diagnosed with BPDCN in the absence of skin manifestation.

참고문헌 (12)

  1. Feuillard J, "Clinical and biologic features of CD4(+)CD56(+) malignancies", Blood, 99, pp.1556~1563 (2002)
  2. Vardiman JW, "The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes", Blood, 114, pp.937~951 (2009)
  3. Burg G, "WHO", EORTC classification of cutaneous lymphomas 2005: histological and molecular aspects, 2005, pp.32, 647~674
  4. Cota C, "Cutaneous manifestations of blastic plasmacytoid dendritic cell neoplasm-morphologic and phenotypic variability in a series of 33 patients", Am J Surg Pathol, 34, pp.75~87 (2010)
  5. Leroux D, "CD4(+), CD56(+) DC2 acute leukemia is characterized by recurrent clonal chromosomal changes affecting 6 major targets: a study of 21 cases by the Groupe Francais de Cytogenetique Hematologique", Blood, 99, pp.4154~4159 (2002)
  6. Lucioni M, "Twenty-one cases of blastic plasmacytoid dendritic cell neoplasm: focus on biallelic locus 9p21.3 deletion", Blood, 118, pp.4591~4594 (2011)
  7. Wiesner T, "Alterations of the cell-cycle inhibitors p27(KIP1) and p16(INK4a) are frequent in blastic plasmacytoid dendritic cell neoplasms", J Invest Dermatol, 130, pp.1152~1157 (2010)
  8. Toya T, "The first case of blastic plasmacytoid dendritic cell neoplasm with MLL-ENL rearrangement", Leuk Res, 36, pp.117~118 (2012)
  9. Wang H, "Blastic plasmacytoid dendritic cell neoplasm without cutaneous lesion at presentation: case report and literature review", Acta Haematol, 127, pp.124~127 (2012)
  10. Bekkenk MW, "CD56+ hematological neoplasms presenting in the skin: a retrospective analysis of 23 new cases and 130 cases from the literature", Ann Oncol, 15, pp.1097~1108 (2004)
  11. Rauh MJ, "Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation, lacking cutaneous involvement: Case series and literature review", Leuk Res, 36, pp.81~86 (2012)
  12. Ham JC, "Allogeneic stem-cell transplantation for blastic plasmacytoid dendritic cell neoplasm", J Clin Oncol, 30, pp.102~103 (2012)

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