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A 70-year-old male with prior medical h istory of diabetes and hypertension is referred by his primary care physician for further evaluation of elevated leukocyte coun t, anemia.' and thrombocytopenia. The patien t initially presen ted to his primary care physician secondary to a 3-week history of progressive rash on his face. as shown below.
Laboratory values reveals a leukocyte count of 57,000/,uL. hemoglobin of 8.2 g/dl and platelets of LJ 3 ,000/,uL. Peripheral blood smear and skin lesion biopsy are shown below.
What is the most likely diagnosis?
- Acute lymphocytic leukemia
- Acute monoblastic leukemia
- Chronic myeloid leukemia
- Chronic lymphocytic leukemia
- Peripheral T-cell lymphoma
Medicine
B. Peripheral blood smear reveals increased number of myeloid blasts exhibiting mono-cytic features. Skin biopsy demonstrates infiltration by a monotonous cell population. The clinical presentation is most consistent with acute monoblastic leukemia (AML-MS by FAB classification) and was confirmed by flow cytometry (CD13, CD33, CD14, CD68 positive). Leukemia cutis pres-ents in approximately 3% of cases of AML (Ann Hematol. 2002;81(2):90); however, it is seen in up to 50% of cases of myelomonocytic and monocytic differentiation (Blood. 1980;55(1 ):71, Blood. 201 1; 1 1 8( 14):3785).
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