Histiocytoid Sweet syndrome may indicate leukemia cutis: a novel application of fluorescence in situ hybridization

J Am Acad Dermatol. 2014 Jun;70(6):1021-7. doi: 10.1016/j.jaad.2014.01.874. Epub 2014 Mar 14.

Abstract

Background: In patients with malignancy-associated Sweet syndrome, a thorough evaluation for leukemia cutis should be considered.

Objective: We sought to describe the clinicopathologic characteristics of histiocytoid Sweet syndrome.

Methods: We retrospectively identified patients with histiocytoid Sweet syndrome at our institution from January 1992 through December 2010. We evaluated the underlying cutaneous infiltrate using immunohistochemistry and fluorescence in situ hybridization.

Results: We re-evaluated all 22 patients with hematologic malignancy-associated Sweet syndrome. Six patients had a monocytoid infiltrate that was consistent with histiocytoid Sweet syndrome; subsequent evaluation of these patients demonstrated cytogenetic abnormalities on prior bone-marrow biopsy specimens. Fluorescence in situ hybridization analysis was feasible in cutaneous specimens from 5 of the 6 patients and demonstrated the same cytogenetic abnormalities that were identified on prior bone-marrow biopsy specimens in 4 patients. Therefore, these 4 patients may have had a form of leukemia cutis.

Limitations: This was a retrospective study.

Conclusion: For patients with histiocytoid Sweet syndrome, an underlying hematologic malignancy, and a monocytoid infiltrate on biopsy specimen, fluorescence in situ hybridization of the cutaneous infiltrate may be beneficial to identify cytogenetic abnormalities that may indicate leukemia cutis.

Keywords: Sweet syndrome; cytogenetic abnormalities; fluorescence in situ hybridization analysis; histiocytoid Sweet syndrome; leukemia cutis; malignancy-associated Sweet syndrome.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Chromosome Aberrations
  • Cohort Studies
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Histiocytes / pathology*
  • Humans
  • Immunohistochemistry
  • In Situ Hybridization, Fluorescence / methods*
  • Incidence
  • Leukemia / diagnosis*
  • Leukemia / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / epidemiology
  • Sweet Syndrome / diagnosis*
  • Sweet Syndrome / epidemiology