skin leukemia
Introduction
Introduction to skin leukemia Leukemiacutis is a malignant tumor of white blood cells in the blood. It is characterized by immature leukocytes diffusely infiltrating the bone marrow and abnormal amounts of immature white blood cells in the blood. In addition, immature white blood cells often infiltrate the liver, spleen, lymph nodes and Other organs include the skin. Clinically, the specific damage of various types of cutaneous leukemia is macules, papules, plaques, nodules, ecchymoses, and palpable purpura. The histological features of most skin leukemias are dense infiltration or diffuse infiltration of atypical white blood cells around blood vessels and glands, and no infiltration under the epidermis. The diagnosis of cutaneous leukemia depends on the majority of cell types in infiltration, the identification of skin infiltration patterns, and the correlation between clinical and hematological examinations. It is impossible to make a diagnosis based solely on the morphological characteristics of leukemia cells. In most cases, cytochemistry and immunohistochemistry are required to accurately determine the source of cutaneous leukemia. basic knowledge The proportion of illness: 0.002% Susceptible people: infants and young children Mode of infection: non-infectious Complications: pneumonia enteritis hypocalcemia
Cause
Causes of cutaneous leukemia
(1) Causes of the disease
The cause is still unknown.
(two) pathogenesis
The pathogenesis is still unclear. Generally, leukemia is divided into the following two types:
1. Myelocytic granulocytic leukemia.
2. Acute myeloid leukemia (AML) accounts for about 50% of acute myeloid leukamia, but leukemia infiltration is rare in AML. Of the 877 patients with acute myeloid leukemia, only 5 patients with AML had skin leukemia infiltration.
Prevention
Skin leukemia prevention
As a difficult disease, leukemia has a variety of complications, which means that these diseases have caused a more declining function of our body. Many people can't stand the pain of suffering, and eventually they die. Beware of infection, when the patient's family is caring for leukemia, be careful to prevent infection. Finding timely treatment of diseases is the key to prevention.
Complication
Dermal leukemia complications Complications pneumonia enteritis hypocalcemia
1, intestinal failure: due to the treatment of leukemia chemotherapy drugs, radiotherapy means affecting gastrointestinal function, resulting in fear of gastric failure, the patient's nutritional supplement has become a prominent problem, currently using the subclavian vein cannula to the superior vena cava High-nutrient infusion only solves some problems, and nutritional deficiency can cause complications such as pneumonia and enteritis.
2, high uric acid blood test: normal people due to nucleic acid metabolism decomposition, daily urine discharge of uric acid 300 ~ 500mg. Leukemia patients can increase uric acid output by several tens of times due to nucleic acid breakdown of a large number of leukemia cells.
3, electrolyte imbalance: white cumulative disease treatment process often due to excessive destruction of leukemia cells or due to chemotherapy drug-induced renal damage and other reasons for excessive potassium. Due to chemotherapy, the dietary taste is poor, the digestive system is dysfunctional, and the amount of hypoxia is low. Or due to the destruction of leukemia cells, the release of phosphorus increases, resulting in low calcium and the like.
Symptom
Symptoms of cutaneous leukemia common symptoms nodular papules genital ulcer skin infiltration gingivitis
The damage is red or purple, slightly elevated papules or nodules. In some cases, the papules can be fused into plaque-like, hemorrhagic lesions can occur, the nodules continue to enlarge and ulcers can form, the lesions are widely distributed, and the most frequently affected parts For the trunk, limbs and neck, but there are also a single large nodule or plaque, there are reports, bullous hemorrhagic lesions and painful genital ulcers such as AMT of the initial damage, about 2% to 4% The patient developed leukemia gingivitis.
Chronic myeloid leukemia (CML)-specific lesions are rare, with a reported incidence of 2% to 8%. Juvenile CML is a rare childhood malignancy characterized by rapid progression of the disease, round red annular plaques and knots. It is seen in a small number of juvenile CML. The green tumor or granulosa cell sarcoma is a rare clinical manifestation of AML or CML. It usually damages single hair, and even multiple, lesions are red, reddish brown or yellowish green nodules or plaques.
Examine
Examination of skin leukemia
1, the total number of blood leukocytes increased slightly, generally not more than 30 × 10 9 / L, the late can be significantly increased, on the contrary, about half of the patients do not increase white blood cells, even as low as 0,4 × 10 9 / L, often different at the onset Degree of anemia, hemoglobin can be rapidly reduced, anemia is normal red blood cells and normal hemoglobin, peripheral red blood cells can appear, see also immature white blood cells, platelets are mostly reduced, with prolonged bleeding time, poor blood clot retraction and capillary fragility test Positive.
2, bone marrow significant proliferation, mainly for leukemia primordial cells, up to 99%, the original white blood cell count of more than 6% have diagnostic value.
3, blood film or bone marrow smear cell chemical staining has a diagnostic value for the identification of different leukemia cells.
4, other plasma albumin decreased, serum gamma globulin in patients with chronic lymphocytic leukemia often decreased, gamma globulin in other types of leukemia patients are mostly normal, chromosome 22 in patients with chronic myeloid leukemia shortened (Ph chromosome).
Histopathology: AML or CML in the upper and deep parts of the dermis see dense leukemia infiltration, and often extend to the subcutaneous tissue, the true epidermis usually has a narrow and no infiltration zone, infiltration is usually diffuse, but also see perivascular infiltration, AML infiltration mainly by It consists of a large medullary cell with a round or oval blister-like nucleus and a small cell with a nucleus. The cells are stained positive with chloroacetate lipase, and common immature atypical myeloid cells and singular nucleus are common. Common mitotic figures in AML infiltration, CML infiltrating cells more morphological, mainly granulosa cells in different stages of differentiation, including atypical myelocytes, late granulocytes, neutrophils, granulosa cell sarcomas from large mature cells to The myeloid cells are composed of immature myeloid cells, which are diffuse and infiltrated in the dermis and subcutaneous tissues.
Histochemistry and immunohistochemistry: lysozyme and myeloperoxidase staining in most AML and CML help identify mature and immature granulosa cells, mature granulosa cells against chloroacetate lipase and alpha-1-antitrypsin Strongly positive, CD43 (1eu22) antibody is a monocyte, and T cell and granulocyte markers are strongly positive in most AML and CML. In most granulosa cell sarcomas, tumor cells are resistant to myeloperoxidase and lysobacteria. The enzyme is strongly positive, and there are also different ratios of leukemia cells positive for Leu-M1 (CD15), Leu-M5 (CD11c), and anti-neutrophil esterase.
Diagnosis
Diagnosis and differentiation of skin leukemia
The diagnosis of cutaneous leukemia depends on the correlation between the majority of cell types and skin infiltration patterns in infiltration and clinical and hematological examinations. It is not possible to make a diagnosis based on the morphological characteristics of leukemia cells alone. Cytochemistry and immunohistochemistry are required to accurately determine the source of skin leukemia.
