Unusual presentation of chronic myelogenous leukemia as multiple skin chloromas: report of a case with clinical and cytologic correlation.

BACKGROUND: Chronic myelogenous leukemia (CML) presenting as multiple skin chloromas is an extremely rare manifestation. Though often seen in acute myelogenous leukemia, to date there have been no reported cases of CML presenting as multiple skin chloromas in the chronic phase. Chloromas in blastic phase of CML at different body sites have been reported previously. CASE: A 53-year-old African American male presented to his primary care provider with multiple skin nodules. A complete blood cound showed a high white cell count, for which he was transferred to a university tertiary care center. Fine needle aspiration (FNA) of the skin lesion revealed cellular smears consisting of immature myeloid cells of CML. Based on these findings, and with clinical correlation, a preliminary diagnosis of chloroma was made and confirmed by ancillary studies.
CONCLUSION: This rare manifestation should alert a clinician to include CML in chronic phase in the differential diagnosis of patients presenting with multiple nonpigmented, nonpruritic skin nodules. FNA with ancillary studies can provide a rapid diagnosis.