Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common form of chronic leukemia in the United States and Europe.1 It has been associated with an increased incidence of a second neoplasia, including carcinomas in various parts of the body. For example, in large population-based studies2,3 of solid tumors in patients with CLL/SLL, markedly increased risks were observed for Kaposi sarcoma, malignant melanoma, and carcinomas of the larynx and the lung. In contrast, occurrence of either synchronous (coexisting) or dyssynchronous (subsequent) poorly differentiated carcinoma and CLL/SLL in the skin is extremely rare. There are, so far, only limited single case reports in the literature.4 The case reported herein is another rare example of a cutaneous colocalized invasive poorly differentiated carcinoma and CLL/SLL of the head and neck region.
Morphologic features of the cutaneous colocalized tumors. A, The infiltrate was located in the dermis without any epidermal involvement. It was composed of 2 components: an epithelial element in the lower left region and a lymphoid element in the upper right region (hematoxylin-eosin, original magnification ×20). B, The epithelial component was composed of markedly atypical large cells with irregular nuclear contours and prominent nucleoli (hematoxylin-eosin, original magnification ×1000). C, The lymphoid component formed discrete nodules composed of small mature lymphocytes (hematoxylin-eosin, original magnification ×100). D, At a higher magnification, the small mature lymphoid cells shown in panel C exhibit round nuclear contours, dense chromatin, absent to small nucleoli with scattered larger lymphoid cells with slight open chromatin, and prominent nucleoli, representing prolymphocytes (arrow) (hematoxylin-eosin, original magnification ×1000.)
Immunohistochemical features of the cutaneous colocalized tumors. The epithelial infiltrate was strongly and diffusely positive for cytokeratin AE1/AE3 (A) and p63 (B). The CD20+ B lymphoid infiltrate (C) coexpressed CD5 (D) compared with scattered CD3+ T lymphocytes (E). (Immunohistochemical staining; original magnification × 100).
Flow cytometric analysis of the skin biopsy specimen. A minute population of B-lineage cells (red) in the lymphoid gate (A) were positive for CD19 (B and C), CD23 (D), dim positive for CD20 (E), and κ light chain–restricted (F). Interestingly, compared with normal mature T lymphocytes (green), the κ-restricted B-lineage cells were also positive for CD5 (usually considered as a pan–T-lymphocyte marker) (B) but negative for CD10 (C), FMC-7 (D), and predominantly negative for CD38 (E).
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