Histology

Specific skin lesions in AML show dense infiltrates in the dermis and subcutaneous tissue with epidermal sparing. The infiltrates typically surround the dermal blood

Figure 2 Acute granulocytic (myeloid) leukemia: oral manifestation with gingival involvement.
Figure 3 Acute granulocytic (myeloid) leukemia (AML, M2). Dermal infiltrate of neoplastic cells showing strong positivity for lysozyme.

vessels, hair follicles, muscle bundles, and sweat glands (13,14). Transmural infiltration of dermal blood vessels and intravascular clusters of atypical myeloid cells may be found. In some instances, vascular injury and even frank vasculitis may be observed (leukemic vasculitis). Typically, the leukemic myeloid cells spread between the collagen bundles and permeate the lobules of subcutaneous tissue. The predominant cell types in AML are medium-sized or large atypical myeloblasts and myelo-cytes with round or oval basophilic nuclei and prominent nucleoli. Immature myeloid cells with large bizarre nuclei can be identified within the dermal infiltrate (14). Occasionally, small lymphocytes and eosinophils can be admixed. Leukemic myeloblasts can be found intermingled with mature neutrophils in inflammatory reactions such as suppurative folliculitis associated with AML subtype Ml (15). In immature AML subtype M0, the infiltrate consists of a monomorphous population of medium-sized blasts with round or folded vesicular nuclei and prominent nucleoli (11). There are usually many mitotic figures.

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