Many faces of the same myeloid neoplasm: a case of leukaemia cutis with mixed histiocytic and Langerhans cell differentiation

Cutaneous involvement by a myeloid neoplasm (myeloid leukaemia cutis), such as chronic myelomonocytic leukaemia (CMML) or acute myeloid leukaemia (AML), can show a spectrum of morphological features and maturation stages, with occasional evidence of histiocytic/dendritic cell differentiation.1 This has to be distinguished from de novo or clonally unrelated histiocytic/dendritic cell neoplasms, which may also arise in patients with underlying myeloid neoplasms. Here, we describe a patient with myeloid leukaemia cutis showing mixed histiocytic and Langerhans cell differentiation arising from underlying CMML/AML. This is an illustrative case of clonal evolution of a myeloid neoplasm that demonstrates at least three distinct constellations of clinical, pathological and molecular findings.

The patient is a 56-year-old man with a prior diagnosis of AML who now presents with a 5-month history of slowly progressive skin nodules. At the time of initial leukaemia diagnosis 10 months prior, the disease was characterised as AML, not...

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