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Relapse in hairy cell leukemia due to isolated nodular skin infiltration.

Leukemic skin infiltration is quite uncommon in certain types of leukemia. Here, a child with hairy cell leukemia who developed isolated skin infiltration during remission is reported. The failure to diagnose the leukemic infiltration until the nodule reached a diameter of 2 cm is emphasized.

Adolescent↗

High incidence of meningeal infiltration by leukemic cells after infection of chimeric virus between neuropathogenic and non-neuropathogenic retroviruses.

Friend murine leukemia virus (F-MuLV) clone A8, previously shown to cause spongiform degeneration in rat brain, induced leukemia within 10 weeks after infection when inoculated into newborn rats. The chimeric virus Rec2, which contains the pol and env genes of 57 virus on the background of A8 and does not cause spongiform degeneration in the central nervous system (CNS), induced leukemic cell infiltration of the CNS, mainly of the meningeal region, in 58.3% of infected rats. In contrast, A8 induced little or no leukemic cell infiltration of the CNS. Other chimeric viruses containing the LTR and the 5' half of the 5' leader sequence of A8 induced aggressive leukemia, and after infection of these viruses, leukemic cell infiltration of the CNS was only observed in less than 20.0% of the rats. These results indicate that the fragment containing the LTR and the 5' half of the 5' leader sequence of A8 is essential for induction of aggressive leukemia in rats but is not sufficient to cause CNS infiltration. We found that leukemic cell infiltration of the CNS is dependent on the sequence of the virus.

3T3 Cells↗

[A case of acute nonlymphocytic leukemia with leukemic cell infiltration to the uterus followed by bone marrow relapse].

A 65-year old female was diagnosed to have acute nonlymphocytic leukemia (M2) in July, 1990. Complete remission was achieved by BHAC-DMP (enocitabine, daunorubicin, 6-mercaptopurine, prednisolone) therapy. Complete remission had continued without symptoms for about two years. Uterial infiltration of leukemic cells occurred in May, 1992, followed by bone marrow relapse after two months. The second hematological complete remission was obtained after one course of the chemotherapy, but uterial infiltration of leukemic cells had still remained.

Aged↗

Pulmonary hypertension in a child with juvenile myelomonocytic leukemia secondary to pulmonary leukemic cell infiltration.

A 4-year-old girl with juvenile myelomonocytic leukemia presented to the emergency room with dyspnea. Echocardiography was performed due to cardiomegaly and prominent main pulmonary artery on a chest X-ray film. On echocardiography the right ventricular pressure calculated from the velocity of tricuspid regurgitation jet was 55 mmHg with no pulmonary stenosis. Despite treatment for pulmonary hypertension and provision of respiratory support, the patient died. A postmortem lung biopsy specimen showed infiltration by tumor cells, which suggested that the pulmonary hypertension had been caused by leukemic infiltration. In conclusion, the findings suggest that leukemic infiltration into the lungs may occur in children with juvenile myelomonocytic leukemia. It should be recognized as a potentially treatable cause of pulmonary hypertension in patients with juvenile myelomonocytic leukemia.

Anti-Bacterial Agents↗

Gingival fine needle aspiration cytology in acute leukemia.

BACKGROUND: Oral findings in acute leukemia (AL) are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection. Gingival enlargement in AL is either due to leukemic infiltration, or due to reactive hyperplasia. To differentiate between them a biopsy is required, but being highly contraindicated, biopsy has been substituted in this study by fine needle aspiration cytology (FNAC). METHOD: Gingival FNAC was performed on different sites in the upper and lower gingiva. Each site represents an interdental papilla, which was selected according to the clinical presentation, i.e., being enlarged or not. Seventy-two adult AL patients received a cytological and clinical examination in this study, and the cases were classified and categorized according to the French-American-British (FAB) criteria. RESULTS: Twenty-one cases were diagnosed as being infiltrated, 16 with gingival enlargement, 4 with no evidence of enlargement. In one case the infiltration affected the alveolar mucosa of an edentulous patient. In six cases the ginigva was enlarged without being infiltrated (reactive hyperplasia). Leukemic gingival enlargement was seen mostly in patients with acute myeloid leukemia, particularly M4 and M5 subtypes; however, two patients with acute mixed lineage leukemia (AMLL) were both affected with leukemic infiltration. CONCLUSION: FNAC was shown to be a simple, non-traumatic and useful diagnostic procedure for screening leukemic infiltration in gingival tissues in AL patients.

Acute Disease↗

Hepatic outflow obstruction and liver failure due to leukemic cell infiltration in chronic lymphocytic leukemia.

We report a patient with advanced progressive CLL who presented with liver failure and hepatic venus outflow obstruction (HVOD) due to lymphocytic leukemic infiltrates. Initiation of antileukemic therapy resulted in a rapid and prompt resolution of these life-threatening complications. This is apparently the first report of a CLL patient with HVOD and liver failure, attributable to liver infiltration by leukemic cells.

Hepatic Veno-Occlusive Disease↗

Acute renal failure due to leukemic cell infiltration followed by relapse at multiple extramedullary sites in a child with acute lymphoblastic leukemia.

Acute renal failure due to leukemic infiltration into the kidney is rare in childhood acute lymphoblastic leukemia (ALL). We report here a five year-old boy with ALL who presented acute renal failure caused by leukemic infiltration at onset. Treatment with predonisolone and hemodialysis was effective. However, he showed persistent or repeated relapses at extramedullary sites, such as central nervous system, testis, and pancreas, suggesting that leukemic cells of this patient may have had a high affinity to extramedullary organs. On the basis of previous reports and the experience of this patient, intensive treatment may be needed in ALL children with renal involvement.

Acute Kidney Injury↗