Cutaneous myeloid sarcoma presenting as grey pigmented macules.

According to previous reports, cutaneous myeloid sar-coma often manifests as a red nodule on the skin. We report here a patient with cutaneous myeloid sarcoma presenting with a unique skin lesion. A 71-year-old man presented with pigmented macules of one month duration. Physical examination showed multiple grey pigmented macules, 10–30 mm in diameter , on the face and trunk (Fig. 1a). His white blood cell count was 2.3 × 10 9 /l, with 8.5% blast cells, 1.0% myeloid cells, 3.5% stab cells, 23.0% segmented neu-trophils, 56.0% lymphocytes, 6.5% monocytes, 0.5% eosinophils, and 0.5% basophils. His platelet count was 7.2 × 10 9 /l, red blood cell count 3.75 × 10 12 /l, and haemoglobin level 10.3 g/dl. Other routine biochemical tests and urinalysis were normal. Microscopic examination showed sheets of cells with abundant eosinophilic cytoplasm, enlarged, frequently reniform, nuclei, and numerous mitotic figures (Fig. 1b). Immunohistoche-mical studies were positive for CD43, CD45, myelo-peroxidase, and lysozyme, and negative for CD3, CD4, CD8, CD20, and CD56, confirming the diagnosis of myeloid sarcoma. When examined at the department of haematology at our request, the patient was diagnosed as having acute myeloid leukaemia with the 7;21 trans-location. On the basis of this diagnosis, the patient was administered induction chemotherapy with intravenous enocitabine and aclarubicin hydrochloride. The macu-les promptly disappeared with this treatment. After 3 courses of chemotherapy, the patient was in complete clinical remission and remained disease-free during a follow-up period of 18 months. DISCUSSION The cutaneous manifestations of leukaemia can be non-specific (containing no leukemic cells), e.g. panni-culitis and generalized pruritus; or specific (leukaemia cutis). Non-specific lesions are found in up to 30% of leukaemia patients (1), but leukaemia cutis is much less common. Skin involvement is usually a late occurrence, and leukaemia cutis preceding marrow or peripheral blood abnormality is extremely rare (2). The clinical manifestations of leukaemia cutis are variable, including macules, nodules, purpura, and erythroderma, and the condition often resembles cutaneous lymphoma. Myeloid sarcoma is an extramedullary tumour of immature cells of granulocytic series, generally occurring in approximately 2% of patients with acute myeloid leukaemia (3). Myeloid sarcoma occurs mostly in adults aged 45–55 years, and it has a predilection for the bone, soft tissue, and skin (4), but they have been found in many other organs, including the abdominal organs, testis, and lacrimal gland. The skin lesions most commonly occur on the trunk, scalp and face. In general, they …