Research Article | Open Access
Volume 2025` - 2 | Article ID 305 | http://dx.doi.org/10.51521/JORCR.2025/e2-1.105
Academic Editor:
1*Khadija Saadi,
2Fatima Ezzohra El Hanafi, 3Meriem El Baz
1*Pediatric Hematology–Oncology Department, Mohammed VI University
Hospital, Marrakech, Email: saadikhadija27@gmail.com
2Pediatric Hematology–Oncology Department, Mohammed VI University Hospital, Marrakech, Cadi Ayyad University, Email: fz.elhanafi@gmail.com
3Pediatric Hematology–Oncology Department, Mohammed VI University Hospital, Marrakech, Cadi Ayyad University, Email: dr.meriemelbaz@gmail.com
Corresponding Author: Pediatric Hematology–Oncology Department,
Mohammed VI University Hospital, Marrakech, Email: saadikhadija27@gmail.com
Citation: Khadija
Saadi, Fatima Ezzohra El Hanafi, Meriem Elbaz, (2025). Subcutaneous Nodules
Revealing Acute Lymphoblastic Leukemia in an Infant: A Case Report and
Literature Review. J Oncol Res Case Rep. 2(1),1-2.
Copyright: © 2025,
Khadija Saadi, et al., This is an open-access article distributed under the
terms of the Creative Commons Attribution 4.0 International License, which
permits unrestricted use, distribution and reproduction in any medium, provided
the original author and source are credited.
Abstract:
Background: Cutaneous involvement at the onset of acute lymphoblastic leukemia (ALL) is uncommon in children and may delay diagnosis, as such lesions are frequently mistaken for benign or infectious processes. Leukemia cutis is particularly rare in pediatric B-ALL, and reports describing subcutaneous nodules as the initial presentation remain limited. Case Presentation: We report the case of a 12-month-old girl who presented with a four-month history of progressively appearing, firm, painless subcutaneous nodules involving the scalp, trunk, and face. Initial laboratory tests revealed bicytopenia without circulating blasts. Biopsy of one nodule showed an undifferentiated small round cell proliferation with immunohistochemical expression of CD45, CD79a, Pax5, CD99, focal CD10, and a high Ki-67 index, consistent with cutaneous infiltration by lymphoblasts. Bone marrow aspiration demonstrated 95% blasts, confirming pro-B acute lymphoblastic leukemia. Cytogenetic analysis identified a pseudodiploid clone with a t(X;10)(p10;p10) translocation. Imaging studies showed diffuse subcutaneous nodular lesions. The patient was treated according to the Marall 2005 high-risk protocol, with rapid regression of the nodules by day 30 of induction and achievement of complete clinical and hematologic remission. Conclusion: This case highlights that persistent, painless subcutaneous nodules in infants may represent an early manifestation of ALL, even when classical hematologic abnormalities are subtle or absent. Early skin biopsy plays a crucial role in accelerating diagnosis and preventing therapeutic delay. Recognizing leukemia cutis as a possible presenting feature of pediatric B-ALL is essential, as timely systemic therapy generally leads to excellent clinical response.
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